Georgia Department of Community Health Validation of Performance Measures for Peach State Health Plan Measurement Period: Calendar Year 2012 Validation Period: State Fiscal Year 2013 Publish Date: September 20, 2013 3133 East Camelback Road, Suite 300 Phoenix, AZ 85016 Phone 602.264.6382 Fax 602.241.0757 CONTENTS for Peach State Health Plan Validation of Performance Measures ................................................................................................... 1 Validation Overview ............................................................................................................................. 1 Care Management Organization (CMO) Information ........................................................................... 1 Performance Measures Validated........................................................................................................ 2 Description of Validation Activities ....................................................................................................... 4 Pre-Audit Strategy ............................................................................................................................. 4 Validation Team................................................................................................................................. 4 Technical Methods of Data Collection and Analysis.......................................................................... 5 On-Site Activities ............................................................................................................................... 5 Data Integration, Data Control, and Performance Measure Documentation ....................................... 7 Data Integration ................................................................................................................................. 7 Data Control ...................................................................................................................................... 7 Performance Measure Documentation.............................................................................................. 7 Validation Results ................................................................................................................................ 8 Medical Service Data (Claims/Encounters) ....................................................................................... 8 Enrollment Data................................................................................................................................. 9 Provider Data..................................................................................................................................... 9 Medical Record Review Process ....................................................................................................... 9 Supplemental Data .......................................................................................................................... 10 Data Integration ............................................................................................................................... 10 Performance Measure Specific Findings......................................................................................... 11 Validation Findings ............................................................................................................................ 12 Appendix A. Data Integration and Control Findings ....................................................................... A-1 Appendix B. Denominator and Numerator Validation Findings..................................................... B-1 Appendix C. Performance Measure Results .................................................................................... C-1 Appendix D. Final Audited HEDIS Rates .......................................................................................... D-1 Appendix E. Performance Measure Validation Reporting Spreadsheet.........................................E-1 Appendix F. HEDIS Interactive Data Submission System Data ...................................................... F-1 Peach State Health Plan Validation of Performance Measures State of Georgia Page i Peach State_GA2012-13_CMO_PMV_F1_0913 Validation of Performance Measures for Peach State Health Plan Validation Overview Validation of performance measures is one of three mandatory external quality review (EQR) activities that the Balanced Budget Act of 1997 (BBA) requires state Medicaid agencies to perform. Health Services Advisory Group, Inc. (HSAG), the external quality review organization (EQRO) for the Department of Community Health (DCH), conducted the validation activities. The DCH contracts with three care management organizations (CMOs) to provide services to Medicaid managed care enrollees and PeachCare for Kids enrollees. PeachCare for Kids is the name of Georgia's stand-alone Children's Health Insurance Program (CHIP). The DCH identified a set of performance measures that were calculated and reported by the CMOs for validation. HSAG conducted the validation activities as outlined in the Centers for Medicare & Medicaid Services (CMS) publication, EQR Protocol 2: Validation of Performance Measures Reported by the MCO: A Mandatory Protocol for External Quality Review (EQR), Version 2.0, September 2012. Care Management Organization (CMO) Information HSAG validated performance measures calculated and reported by Peach State Health Plan (Peach State). Information about Peach State appears in Table 1. Table 1--Peach State Health Plan Information CMO Name: CMO Location: CMO Contact: Peach State Health Plan 3200 Highlands Parkway SE, Suite 300 Smyrna, GA 30082 Joyce McElwain, Senior Director, Quality Improvement Contact Telephone Number: 678.556.2344 Contact E-mail Address: jmcelwain@centene.com Site Visit Date: April 18, 2013 Peach State Health Plan Validation of Performance Measures State of Georgia Page 1 Peach State_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES Performance Measures Validated HSAG validated performance measures identified and selected by DCH for validation. All performance measures were selected from the Centers for Medicare & Medicaid Services' (CMS) Initial Core Set of Children's Health Care Quality Measures,1 the Initial Core Set of Health Care Quality Measures for Adults Enrolled in Medicaid,2 or the Agency for Healthcare Research and Quality (AHRQ). The measurement period was identified by DCH as calendar year (CY) 2012 for all measures except the two child core set dental measures. The dental measures were reported for federal fiscal year (FFY) 2012, which covered the time frame of October 1, 2011, through September 30, 2012, per CMS requirements. Table 2 lists the performance measures that HSAG validated and identifies who calculated the performance measure rates. Table 2--List of CY 2012 Performance Measures for Peach State Performance Measure 1. Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517) Annual Percentage of Asthma Patients with One 2. or More Asthma-Related Emergency Room Visit (ages 220) 3. Cesarean Delivery Rate 4. Cesarean Rate for Nulliparous Singleton Vertex 5. Percentage of Eligibles that Received Dental Treatment Services 6. Percentage of Eligibles that Received Preventive Dental Services 7. Percentage of Live Births Weighing Less Than 2,500 Grams 8. Adult Asthma Admission Rate 9. Chronic Obstructive Pulmonary Disease (COPD) Admission Rate 10. Congestive Heart Failure Admission Rate 11. Diabetes, Short-Term Complications Admission Rate Method Hybrid3 Admin Admin Admin Admin Admin Admin Admin Admin Admin Admin Specifications CMS Child Core Set CMS Child Core Set AHRQ CMS Child Core Set4 CMS Child Core Set CMS Child Core Set CMS Child Core Set/AHRQ CMS Adult Core Set CMS Adult Core Set CMS Adult Core Set CMS Adult Core Set Rate Calculation by: Peach State Peach State Peach State Peach State Peach State Peach State Peach State Peach State Peach State Peach State Peach State 1 The Centers for Medicare & Medicaid Services. Initial Core Set of Children's Health Care Quality Measures, November 2012. 2 The Centers for Medicare & Medicaid Services. Initial Core Set of Health Care Quality Measures for Adults Enrolled in Medicaid, February 2013. 3 Hybrid measures require both administrative data and medical record review. 4 The CMS measure specifications were modified by HSAG. Peach State Health Plan Validation of Performance Measures State of Georgia Page 2 Peach State_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES In addition to the AHRQ and the CMS adult and child core set measures audited by HSAG, DCH required Peach State to report a selected set of Healthcare Effectiveness Data and Information Set (HEDIS) measures to DCH. Peach State was required to contract with an NCQA-licensed audit organization and undergo an NCQA HEDIS Compliance AuditTM. Final audited HEDIS measure results from NCQA's Interactive Data Submission System (IDSS) were submitted to HSAG and provided to DCH. Appendices D and E display the final audited HEDIS 2013 results for all required measures, covering the 2012 measurement period. HSAG will use these results in addition to the measures HSAG validated and displayed within this report as data sources for the annual EQR technical report. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). HEDIS Compliance AuditTM is a trademark of the National Committee for Quality Assurance (NCQA). Peach State Health Plan Validation of Performance Measures State of Georgia Page 3 Peach State_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES Description of Validation Activities Pre-Audit Strategy HSAG conducted the validation activities as outlined in the CMS performance measure validation protocol. To complete the validation activities for Peach State, HSAG obtained a list of the measures that were selected by DCH for validation. HSAG then prepared a document request letter that was submitted to Peach State outlining the steps in the performance measure validation process. The document request letter included a request for source code for each performance measure; a completed HEDIS 2013 Record of Administration, Data Management, and Processes (Roadmap); and any additional supporting documentation necessary to complete the audit. HSAG responded to Roadmap-related questions received directly from Peach State during the pre-on-site phase. For the on-site visit, HSAG prepared an agenda describing all visit activities and indicating the type of staffing needed for each session. HSAG provided the agenda to Peach State approximately one week prior to the on-site visit. HSAG also conducted a pre-on-site conference call with Peach State to discuss any outstanding Roadmap questions and on-site visit activity expectations. Validation Team The HSAG Performance Measure Validation Team was composed of a lead auditor and validation team members. HSAG assembled the team based on the skills required for the validation and requirements of Peach State. Some team members, including the lead auditor, participated in the onsite meetings at Peach State; others conducted their work at HSAG's offices. Table 3 lists the validation team members, their positions, and their skills and expertise. Table 3--Validation Team Name and Role Skills and Expertise Patience Hoag, RHIT, CHCA, CHDA, CCS, CCS-P, Certified HEDIS auditor, certified coder; HEDIS CPHQ knowledge, interviewing skills, data analysis, Lead Auditor abstraction, tool development, and quality improvement. Judy Yip, PhD Source Code Review Manager and Audit Specialist, Audits Auditing experience, HEDIS knowledge, performance measure knowledge, and source code review management. Tammy GianFrancisco Project Leader, Audits Performance measure validation coordination, communication, and scheduling. Peach State Health Plan Validation of Performance Measures State of Georgia Page 4 Peach State_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES Technical Methods of Data Collection and Analysis The CMS performance measures validation protocol identifies key types of data that should be reviewed as part of the validation process. The following list describes the type of data collected and how HSAG conducted an analysis of these data: NCQA's HEDIS 2013 Roadmap: Peach State completed and submitted the required and relevant portions of its Roadmap for review by the validation team. The validation team used responses from the Roadmap to complete the pre-on-site assessment of information systems. Source code (programming language) for performance measures: Peach State contracted with Inovalon, an NCQA-Certified software vendor, to calculate rates for both HEDIS and nonHEDIS measures. The source code review was conducted via a Web-assisted session where Inovalon explained the process and source code to HSAG's source code review team. Supporting documentation: HSAG requested documentation that would provide reviewers with additional information to complete the validation process, including policies and procedures, file layouts, system flow diagrams, system log files, and data collection process descriptions. The validation team reviewed all supporting documentation, identifying issues or areas needing clarification for further follow-up. On-Site Activities HSAG conducted an on-site visit with Peach State on April 18, 2013. HSAG collected information using several methods, including interviews, system demonstration, review of data output files, primary source verification, observation of data processing, and review of data reports. The on-site visit activities are described as follows: Opening meeting: The opening meeting included an introduction of the validation team and key Peach State staff members involved in the performance measure activities. The review purpose, the required documentation, basic meeting logistics, and queries to be performed were discussed. Evaluation of system compliance: The evaluation included a review of the information systems, focusing on the processing of claims and encounter data, provider data, patient data, and inpatient data. Additionally, the review evaluated the processes used to collect and calculate the performance measure rates, including accurate numerator and denominator identification and algorithmic compliance (which evaluated whether rate calculations were performed correctly, all data were combined appropriately, and numerator events were counted accurately). Review of Roadmap and supporting documentation: The review included processes used for collecting, storing, validating, and reporting performance measure rates. This session was designed to be interactive with key Peach State staff members so that the validation team could obtain a complete picture of all the steps taken to generate the performance measure rates. The goal of the session was to obtain a confidence level as to the degree of compliance with written documentation compared to the actual process. HSAG conducted interviews to confirm findings from the documentation review, expand or clarify outstanding issues, and ascertain that written policies and procedures were used and followed in daily practice. Peach State Health Plan Validation of Performance Measures State of Georgia Page 5 Peach State_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES Overview of data integration and control procedures: The overview included discussion and observation of source code logic, a review of how all data sources were combined, and a review of how the analytic file was produced for the reporting of selected performance measure rates. HSAG performed primary source verification to further validate the output files and reviewed backup documentation on data integration. HSAG also addressed data control and security procedures during this session. Closing conference: The closing conference included a summation of preliminary findings based on the review of the Roadmap and the on-site visit, and revisited the documentation requirements for any post-visit activities. HSAG conducted several interviews with key Peach State staff members who were involved with performance measure reporting. Table 4 lists key Peach State interviewees: Alfred Miller Table 4--List of Peach State Health Plan Interviewees Name Title Data Analyst III Detra Friley-Clark Director, Provider Data and Credentialing Joyce McElwain Senior Director, Quality Improvement Ron Purisima Manager, Quality Analytics Dean Greeson Senior Vice President, Medical Director Donna McIntosh Senior Director, Compliance Shaywen Hawkins Quality Improvement Manager Andrea Stuckey-Hendley Project Manager, Compliance Chevron Cardenas Senior Director, Member and Provider Services Heather House Farmington Claims Supervisor Jessica Silver Corporate Director, Encounters Kimberly Weakley Vice President, Provider Solutions Debra Peterson-Smith Senior Vice President, Operations Luke Ferguson Encounters Analyst Tonnette Tucker Supervisor, Provider Data Management Inez Sarves Contract Management Wanda Lee Member Service Manager Jason Rosen Senior Health Economics Analyst Brian Daming Information Technology QSI Technician Valerie Liserio-Eike Quality Improvement Specialist--HEDIS Yolanda Spivey Senior Director, Data Analytics Peach State Health Plan Validation of Performance Measures State of Georgia Page 6 Peach State_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES Data Integration, Data Control, and Performance Measure Documentation There are several aspects crucial to the calculation of performance measure rates. These include data integration, data control, and documentation of performance measure calculations. Each of the following sections describes the validation processes used and the validation findings. For more detailed information, see Appendix A of this report. Data Integration Accurate data integration is essential for calculating valid performance measure rates. The steps used to combine various data sources (including claims/encounter data, eligibility data, and other administrative data) must be carefully controlled and validated. HSAG validated the data integration process used by Peach State, which included a review of file consolidations or extracts, a comparison of source data to warehouse files, data integration documentation, source code, production activity logs, and linking mechanisms. Overall, the validation team determined that the data integration processes in place at Peach State were: Acceptable Not acceptable Data Control Peach State's organizational infrastructure must support all necessary information systems; and its quality assurance practices and backup procedures must be sound to ensure timely and accurate processing of data, and to provide data protection in the event of a disaster. HSAG validated the data control processes Peach State used which included a review of disaster recovery procedures, data backup protocols, and related policies and procedures. Overall, the validation team determined that the data control processes in place at Peach State were: Acceptable Not acceptable Performance Measure Documentation Sufficient, complete documentation is necessary to support validation activities. While interviews and system demonstrations provided supplementary information, the majority of the validation review findings were based on documentation provided by Peach State. HSAG reviewed all related documentation, which included the completed Roadmap, job logs, computer programming code, output files, work flow diagrams, narrative descriptions of performance measure calculations, and other related documentation. Overall, the validation team determined that the documentation of performance measure calculations by Peach State was: Acceptable Not acceptable Peach State Health Plan Validation of Performance Measures State of Georgia Page 7 Peach State_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES Validation Results The validation team evaluated Peach State's data systems for processing of each type of data used for reporting DCH performance measure rates. General findings are indicated below: Medical Service Data (Claims/Encounters) There were no concerns with Peach State's medical service data system or processes. The plan continued to use Amisys as its transactional system, which had sufficient edits in place to ensure data were complete and accurate upon entry/loading into the system. All data elements needed for reporting the performance measures were captured. All providers submitted data in standard formats, using industry standard codes. Over 90 percent of Peach State's providers and facilities submitted claims data electronically, which instilled additional confidence in data accuracy. Paper claims were received at the corporate office in Farmington, Missouri; scanned via optical character recognition (OCR) technology; and loaded into Amisys for processing. Minimal data were manually entered into Amisys. The plan's reimbursement structure is fee-for-service (FFS), which serves as a built-in incentive for providers to submit data to the plan. Peach State's claims processors are audited on an ongoing basis, and all processors met standards for the measurement year for payment, financial, and processing accuracy. The entire process from data submission to claims processing is highly automated, with very little manual intervention. The plan successfully transitioned to the 5010 format, and most of its providers had also transitioned during 2012. Claims submitted by providers using the 4010 format were rejected for reimbursement, which encouraged providers to submit claims with the updated format. The plan was also proactively planning for ICD-10 implementation, having begun mapping and other preparations for the transition in the code set in 2014. Although the plan's reimbursement structure helps ensure that providers are submitting complete data, the plan also ran various monitoring reports to track providers' claim submission volumes. If a high-volume provider were to suspend submission of claims to the plan, this action would be quickly identified. Peach State used DentaQuest to process its dental claims. Although DentaQuest underwent a system transition during late 2011, the transition went smoothly, and there were no issues related to data loss. Thorough testing prior to implementation included running dual systems and comparing results to historical data. DentaQuest sent encounter files to Peach State twice each month, and the encounters were then loaded to the data warehouse. There were no issues or concerns with the completeness or integrity of the data in 2012, as ongoing monitoring of volume occurs as a part of data receipt and loading. Peach State contracted with US Script to serve as its pharmacy vendor. Data were submitted to Peach State at least weekly and included paid, denied, and reversal claims data. These data were loaded to the plan's data warehouse for use in measure reporting. There were no issues with data format, timeliness, or completeness in 2012. Peach State Health Plan Validation of Performance Measures State of Georgia Page 8 Peach State_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES A recommendation for more formal documentation of vendor monitoring was made during the previous performance measure validation review and discussed during the on-site review. Peach State conducted meetings with each of its vendors monthly (weekly for those not meeting performance standards) to discuss any issues or concerns, and maintained documentation of this interaction. The plan's Finance department also performed oversight of pharmacy transactional and payment volumes, which was documented. In addition, the plan submitted a comprehensive document for auditor review, GA CMO Encounter Report. The report was produced by an accounting firm and showed detailed financial information based on data provided by each of the plan's vendors. Enrollment Data Peach State had effective processes for acquiring and loading enrollment data from the State's fiscal agent. The plan had a highly electronic, well-coordinated, and long-standing method for acquisition and loading of State enrollment files. Daily 834 changes/addition files were acquired via secure file transfer protocol, processed for edit checks, and then uploaded into Amisys, the transactional system. Error reports were generated identifying discrepancies that needed to be manually worked. The plan also received a full monthly enrollment file, which included demographic changes, terminations, additions, and voids. The State's fiscal agent also provided an end-of-month adjustment file that included voided transactions (e.g., the member was not or never was eligible). Any discrepancies requiring research were identified through automated reports and corrected efficiently, with monthly reporting to the State for any member data discrepancies that had not been corrected. There were no backlogs during 2012. The auditor had no concerns with Peach State's enrollment data. Provider Data There were no concerns with the plan's provider data system or processes. The plan used the Portico system to house provider data. This software application interfaces seamlessly with Amisys, which helps to eliminate reconciliation concerns. Peach State conducts 100 percent validation of all data entry of its direct providers and continually monitors delegated entities' data. The number of primary care physicians increased during 2012 due to the plan's expansion initiative, which delayed some provider data entry. The delay was quickly remedied, however, because staffing was immediately increased to accommodate the influx. Medical Record Review Process Peach State was fully compliant with the medical record review reporting requirements. Peach State used the vendor, RecordFlow, to procure the medical records, and another vendor, Aqurate Health Data Management, to abstract and enter the medical record data into the Aqurate hybrid tool. HSAG reviewed the Aqurate hybrid tool and corresponding instructions. Aqurate's reviewer qualifications, training, and oversight were appropriate. Peach State's oversight of the medical record abstraction and procurement vendors was appropriate. Due to reporting a new State-required hybrid measure, a convenience sample was required and subsequently passed review. Peach State passed the medical record review validation process for the Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517) measure. Peach State Health Plan Validation of Performance Measures State of Georgia Page 9 Peach State_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES Supplemental Data Peach State did not use supplemental data to augment rates for the measures under the scope of the audit; therefore, this standard is not applicable. Data Integration Peach State contracted with Inovalon to generate the various non-HEDIS performance measure rates for the measures under the scope of the audit, as well as the plan's HEDIS rates. Staff members at Peach State responsible for measure reporting activities were very experienced and well-versed in all aspects of the performance measure reporting process, and they were very responsive to any and all pre-onsite, on-site, and post-onsite requests. For data integration, all source data were pulled from Peach State's enterprise data warehouse into a staging database prior to loading into Inovalon's certified software, Quality Spectrum Insight (QSI). There were communications with Inovalon to ensure that all data elements needed for deriving the measures were provided. For each file provided to Inovalon, row counts and other automated reports were run to ensure that data transfers into QSI were completed, and no data were lost or corrupted. In addition to the certified software for HEDIS measures, Inovalon produced the programming code based on the performance measure specifications for the non-HEDIS measures. HSAG reviewed and approved Inovalon's programming code for the non-HEDIS performance measures. There were no further concerns with Peach State's data integration system or processes to generate its rates. Peach State Health Plan Validation of Performance Measures State of Georgia Page 10 Peach State_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES Performance Measure Specific Findings Based on all validation activities, the HSAG Performance Measure Validation Team determined validation results for each performance measure rate. Table 5 displays the key review results. For detailed information, see Appendix B of this report. Table 5--Key Review Results for Peach State Health Plan Performance Measures Key Review Findings 1. Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517) No concerns were identified. 2. Annual Percentage of Asthma Patients with One or More AsthmaRelated Emergency Room Visit (ages 220) No concerns were identified. 3. Cesarean Delivery Rate No concerns were identified. 4. Cesarean Rate for Nulliparous Singleton Vertex No concerns were identified. 5. Percentage of Eligibles that Received Dental Treatment Services No concerns were identified. 6. Percentage of Eligibles that Received Preventive Dental Services No concerns were identified. 7. Percentage of Live Births Weighing Less Than 2,500 Grams No concerns were identified. 8. Adult Asthma Admission Rate No concerns were identified. 9. Chronic Obstructive Pulmonary Disease (COPD) Admission Rate No concerns were identified. 10. Congestive Heart Failure Admission Rate No concerns were identified. 11. Diabetes, Short-Term Complications Admission Rate No concerns were identified. Peach State Health Plan Validation of Performance Measures State of Georgia Page 11 Peach State_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES Validation Findings HSAG provided an audit designation for each performance measure as defined in Table 6: Report (R) Table 6--Validation Findings Definitions The organization followed the specifications and produced a reportable rate or result for the measure. Not Reportable (NR) The calculated rate was materially biased, or the organization chose not to report the measure, or the organization was not required to report the measure. According to the CMS protocol, the validation finding for each measure is determined by the magnitude of the errors detected for the audit elements, not by the number of audit elements determined to be "Not Reportable." Consequently, it is possible that an error for a single audit element may result in a designation of "NR" because the impact of the error biased the reported performance measure rate by more than 5 percentage points. Conversely, it is also possible that several audit element errors may have little impact on the reported rate, resulting in a measure designation of "R." Table 7 shows the final validation findings for Peach State for each performance measure rate. For additional information regarding performance measure rates, see Appendix C of this report. Table 7--Key Review Results for Peach State Health Plan Performance Measures Validation Finding 1. Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517) R 2. Annual Percentage of Asthma Patients with One or More AsthmaRelated Emergency Room Visit (ages 220) R 3. Cesarean Delivery Rate R 4. Cesarean Rate for Nulliparous Singleton Vertex R 5. Percentage of Eligibles that Received Dental Treatment Services R 6. Percentage of Eligibles that Received Preventive Dental Services R 7. Percentage of Live Births Weighing Less Than 2,500 Grams R 8. Adult Asthma Admission Rate R 9. Chronic Obstructive Pulmonary Disease (COPD) Admission Rate R 10. Congestive Heart Failure Admission Rate R 11. Diabetes, Short-Term Complications Admission Rate R Peach State Health Plan Validation of Performance Measures State of Georgia Page 12 Peach State_GA2012-13_CMO_PMV_F1_0913 Appendix A. Data Integration and Control Findings for Peach State Health Plan Documentation Worksheet CMO Name: On-Site Visit Date: Reviewers: Peach State Health Plan April 18, 2013 Patience Hoag, RHIT, CHCA, CHDA, CCS, CCS-P, CPHQ Table A-1--Data Integration and Control Findings for Peach State Health Plan Data Integration and Control Element Not Met Met N/A Comments Accuracy of data transfers to assigned performance measure data repository. The CMO accurately and completely processes transfer data from the transaction files (e.g., membership, provider, encounter/claims) into the performance measure data repository used to keep the data until the calculations of the performance measures have been completed and validated. Samples of data from the performance measure data repository are complete and accurate. Accuracy of file consolidations, extracts, and derivations. The CMO's processes to consolidate diversified files and to extract required information from the performance measure data repository are appropriate. Actual results of file consolidations or extracts are consistent with those that should have resulted according to documented algorithms or specifications. Procedures for coordinating the activities of multiple subcontractors ensure the accurate, timely, and complete integration of data into the performance measure database. Computer program reports or documentation reflect vendor coordination activities, and no data necessary to performance measure reporting are lost or inappropriately modified during transfer. If the CMO uses a performance measure data repository, its structure and format facilitates any required programming necessary to calculate and report required performance measures. The performance measure data repository's design, program flow charts, and source codes enable analyses and reports. Proper linkage mechanisms are employed to join data from all necessary sources (e.g., identifying a member with a given disease/condition). Peach State Health Plan Validation of Performance Measures State of Georgia Page A-1 Peach State_GA2012-13_CMO_PMV_F1_0913 DATA INTEGRATION AND CONTROL FINDINGS Table A-1--Data Integration and Control Findings for Peach State Health Plan Data Integration and Control Element Not Met Met N/A Comments Assurance of effective management of report production and of the reporting software. Documentation governing the production process, including CMO production activity logs and the CMO staff review of report runs, is adequate. Prescribed data cutoff dates are followed. The CMO retains copies of files or databases used for performance measure reporting in case results need to be reproduced. The reporting software program is properly documented with respect to every aspect of the performance measure data repository, including building, maintaining, managing, testing, and report production. The CMO's processes and documentation comply with the CMO standards associated with reporting program specifications, code review, and testing. Peach State Health Plan Validation of Performance Measures State of Georgia Page A-2 Peach State_GA2012-13_CMO_PMV_F1_0913 Appendix B. Denominator and Numerator Validation Findings for Peach State Health Plan Reviewer Worksheets CMO Name: On-Site Visit Date: Reviewers: Peach State Health Plan April 18, 2013 Patience Hoag, RHIT, CHCA, CHDA, CCS, CCS-P, CPHQ Table B-1--Denominator Validation Findings for Peach State Health Plan Audit Element Not Met Met N/A Comments For each of the performance measures, all members of the relevant populations identified in the performance measure specifications are included in the population from which the denominator is produced. Adequate programming logic or source code exists to appropriately identify all relevant members of the specified denominator population for each of the performance measures. The CMO correctly calculates member months and member years if applicable to the performance measure. The CMO properly evaluates the completeness and accuracy of any codes used to identify medical events, such as diagnoses, procedures, or prescriptions, and these codes are appropriately identified and applied as specified in each performance measure. If any time parameters are required by the specifications of the performance measure, they are followed (e.g., cutoff dates for data collection, counting 30 calendar days after discharge from a hospital). Exclusion criteria included in the performance measure specifications are followed. Systems or methods used by the CMO to estimate populations when they cannot be accurately or completely counted (e.g., newborns) are valid. Population estimates were not necessary. Peach State Health Plan Validation of Performance Measures State of Georgia Page B-1 Peach State_GA2012-13_CMO_PMV_F1_0913 DENOMINATOR AND NUMERATOR VALIDATION FINDINGS Table B-2--Numerator Validation Findings for Peach State Health Plan Audit Element Not Met Met N/A Comments The CMO uses the appropriate data, including linked data from separate data sets, to identify the entire at-risk population. Qualifying medical events (such as diagnoses, procedures, prescriptions, etc.) are properly identified and confirmed for inclusion in terms of time and services. The CMO avoids or eliminates all double-counted members or numerator events. Any nonstandard codes used in determining the numerator are mapped to a standard coding scheme in a manner that is consistent, complete, and reproducible, as evidenced by a review of the programming logic or a demonstration of the program. Nonstandard codes were not used or reported. If any time parameters are required by the specifications of the performance measure, they are followed (i.e., the measured event occurred during the time period specified or defined in the performance measure). Peach State Health Plan Validation of Performance Measures State of Georgia Page B-2 Peach State_GA2012-13_CMO_PMV_F1_0913 Appendix C. Performance Measure Results for Peach State Health Plan Performance Measure 1--Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517) Table C-1--Performance Measure 1 for Peach State Health Plan Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517) Rate 83.38% Performance Measure 2--Annual Percentage of Asthma Patients with One or More Asthma-Related Emergency Room Visit (ages 220) Table C-2--Performance Measure 2 for Peach State Health Plan Annual Percentage of Asthma Patients with One or More Asthma-Related Emergency Room Visit (ages 220) Rate 12.64% Performance Measure 3--Cesarean Delivery Rate Table C-3--Performance Measure 3 for Peach State Health Plan Cesarean Delivery Rate Rate 30.01% Performance Measure 4--Cesarean Rate for Nulliparous Singleton Vertex Table C-4--Performance Measure 4 for Peach State Health Plan Cesarean Rate for Nulliparous Singleton Vertex Rate 19.63% Peach State Health Plan Validation of Performance Measures State of Georgia Page C-1 Peach State_GA2012-13_CMO_PMV_F1_0913 PERFORMANCE MEASURE RESULTS Performance Measure 5--Percentage of Eligibles that Received Dental Treatment Services Table C-5--Performance Measure 5 for Peach State Health Plan Percentage of Eligibles that Received Dental Treatment Services Rate 23.14% Performance Measure 6--Percentage of Eligibles that Received Preventive Dental Services Table C-6--Performance Measure 6 for Peach State Health Plan Percentage of Eligibles that Received Preventive Dental Services Rate 48.06% Performance Measure 7--Percentage of Live Births Weighing Less Than 2,500 Grams Table C-7--Performance Measure 7 for Peach State Health Plan Percentage of Live Births Weighing Less Than 2,500 Grams Rate 8.53% Performance Measure 8--Adult Asthma Admission Rate Table C-8--Performance Measure 8 for Peach State Health Plan Adult Asthma Admission Rate Rate (Per 100,000) 52.17 Peach State Health Plan Validation of Performance Measures State of Georgia Page C-2 Peach State_GA2012-13_CMO_PMV_F1_0913 PERFORMANCE MEASURE RESULTS Performance Measure 9--Chronic Obstructive Pulmonary Disease (COPD) Admission Rate Table C-9--Performance Measure 9 for Peach State Health Plan Chronic Obstructive Pulmonary Disease (COPD) Admission Rate Rate (Per 100,000) 18.87 Performance Measure 10--Congestive Heart Failure Admission Rate Table C-10--Performance Measure 10 for Peach State Health Plan Congestive Heart Failure Admission Rate Rate (Per 100,000) 25.53 Performance Measure 11--Diabetes, Short-Term Complications Admission Rate Table C-11--Performance Measure 11 for Peach State Health Plan Diabetes, Short-Term Complications Admission Rate Rate (Per 100,000) 25.52 Peach State Health Plan Validation of Performance Measures State of Georgia Page C-3 Peach State_GA2012-13_CMO_PMV_F1_0913 Appendix D. Final Audited HEDIS Rates for Peach State Health Plan Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for Peach State Health Plan Measure CMO Rate Adolescent Well-Care Visits 43.98% Adults' Access to Preventive/Ambulatory Health Services-- Ages 2044 Years Adults' Access to Preventive/Ambulatory Health Services-- Ages 4564 Years Adults' Access to Preventive/Ambulatory Health Services-- Ages 65+ Years 84.94% 89.36% Denominator fewer than 30 Adults' Access to Preventive/Ambulatory Health Services--Total 85.46% Adult BMI Assessment 66.59% Annual Dental Visit--Ages 23 Years 43.96% Annual Dental Visit--Ages 46 Years 76.01% Annual Dental Visit--Ages 710 Years 78.32% Annual Dental Visit--Ages 1114 Years 70.02% Annual Dental Visit--Ages 1518 Years 59.42% Annual Dental Visit--Ages 1921 Years 38.85% Annual Dental Visit--Total Annual Monitoring for Patients on Persistent Medications-- ACE Inhibitors or ARBs Annual Monitoring for Patients on Persistent Medications-- Anticonvulsants Annual Monitoring for Patients on Persistent Medications--Digoxin 67.92% 87.92% 63.41% Denominator fewer than 30 Annual Monitoring for Patients on Persistent Medications--Diuretics 87.90% Annual Monitoring for Patients on Persistent Medications--Total Antibiotic Utilization--Percent of Antibiotics of Concern of All Antibiotic Scrips--Total Antidepressant Medication Management--Effective Acute Phase Treatment Antidepressant Medication Management--Effective Continuation Phase Treatment Appropriate Testing for Children with Pharyngitis 86.87% 40.84% 43.92% 28.13% 73.80% Peach State Health Plan Validation of Performance Measures State of Georgia Page D-1 Peach State_GA2012-13_CMO_PMV_F1_0913 FINAL AUDITED HEDIS RATES Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for Peach State Health Plan Measure CMO Rate Appropriate Treatment for Children with Upper Respiratory Infection (URI)* 80.47% Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis* 17.31% Breast Cancer Screening 56.46% Call Answer Timeliness 82.84% Cervical Cancer Screening Cholesterol Management for Patients with Cardiovascular Conditions-- LDL-C Screening Cholesterol Management for Patients with Cardiovascular Conditions-- LDL-C Control Childhood Immunization Status--Combo 3 73.54% 74.55% 23.64% 76.74% Childhood Immunization Status--Combo 6 33.26% Childhood Immunization Status--Combo 10 Children's and Adolescents' Access to Primary Care Providers--Ages 1224 Months Children's and Adolescents' Access to Primary Care Practitioners -- Ages 25 Months6 Years Children's and Adolescents' Access to Primary Care Practitioners -- Ages 711 Years Children's and Adolescents' Access to Primary Care Practitioners -- Ages 1219 Years Chlamydia Screening in Women 27.91% 96.98% 90.43% 90.81% 87.97% 59.60% Comprehensive Diabetes Care--Blood Pressure Control <140/80 27.30% Comprehensive Diabetes Care--Blood Pressure Control <140/90 53.74% Comprehensive Diabetes Care--Eye Exam 57.22% Comprehensive Diabetes Care--HbA1c Control <7.0 27.61% Comprehensive Diabetes Care--HbA1c Control <8.0 39.13% Comprehensive Diabetes Care--HbA1c Poor Control >9.0 ** 55.48% Comprehensive Diabetes Care--HbA1c Testing 79.83% Comprehensive Diabetes Care--LDL-C Screening 67.83% Comprehensive Diabetes Care--LDL-C Control 20.35% Comprehensive Diabetes Care--Medical Attention to Nephropathy 73.39% Peach State Health Plan Validation of Performance Measures State of Georgia Page D-2 Peach State_GA2012-13_CMO_PMV_F1_0913 FINAL AUDITED HEDIS RATES Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for Peach State Health Plan Measure CMO Rate Controlling High Blood Pressure 49.78% Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis 68.42% Follow-Up After Hospitalization for Mental Illness--30 Day Follow-Up 70.79% Follow-Up After Hospitalization for Mental Illness--7 Day Follow-Up Follow-Up Care for Children Prescribed ADHD Medication--Initiation Phase Follow-Up Care for Children Prescribed ADHD Medication-- Continuation and Maintenance Phase Frequency of Ongoing Prenatal Care--< 21 Percent 52.52% 43.73% 58.60% 8.62% Frequency of Ongoing Prenatal Care--2140 Percent 4.43% Frequency of Ongoing Prenatal Care--4160 Percent 6.99% Frequency of Ongoing Prenatal Care--6180 Percent 14.92% Frequency of Ongoing Prenatal Care--81+ Percent Human Papillomavirus Vaccine for Female Adolescents Immunizations for Adolescents--Combo 1 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment--Initiation of Treatment Initiation and Engagement of Alcohol and Other Drug Dependence Treatment--Engagement of Treatment Inpatient Utilization--General Hospital/Acute Care--Total Lead Screening in Children Asthma Medication Ratio--Total: 564 Years Medication Management for People with Asthma-- Total-Medication Compliance 50% Medication Management for People with Asthma-- Total-Medication Compliance 75% Persistence of Beta-Blocker Treatment After a Heart Attack Pharmacotherapy Management of COPD Exacerbation-- Systemic Corticosteroid Pharmacotherapy Management of COPD Exacerbation-- Bronchodilator Prenatal and Postpartum Care--Postpartum Care Prenatal and Postpartum Care--Timeliness of Prenatal Care 65.03% 17.82% 71.30% 39.74% 8.27% Rates reported in Appendix F 74.19% 60.77% 40.08% 18.44% Denominator fewer than 30 63.64% 78.18% 71.56% 86.71% Peach State Health Plan Validation of Performance Measures State of Georgia Page D-3 Peach State_GA2012-13_CMO_PMV_F1_0913 FINAL AUDITED HEDIS RATES Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for Peach State Health Plan Measure CMO Rate Use of Appropriate Medications for People with Asthma-- Ages 511 Years Use of Appropriate Medications for People with Asthma-- Ages 1218 Years 90.58% 88.40% Use of Appropriate Medications for People with Asthma-- Ages 1950 Years Use of Appropriate Medications for People with Asthma-- Ages 5164 Years 72.39% Denominator fewer than 30 Use of Appropriate Medications for People with Asthma--Total 89.22% Use of Imaging Studies for Low Back Pain* 78.26% Use of Spirometry Testing in the Assessment and Diagnosis of COPD Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--Total BMI Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--Total Nutrition Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--Total Physical Activity Well-Child Visits in the First 15 Months of Life--Zero Visits 40.82% 47.69% 56.02% 47.69% 4.63% Well-Child Visits in the First 15 Months of Life--One Visit 3.24% Well-Child Visits in the First 15 Months of Life--Two Visits 4.86% Well-Child Visits in the First 15 Months of Life--Three Visits 4.63% Well-Child Visits in the First 15 Months of Life--Four Visits 11.34% Well-Child Visits in the First 15 Months of Life--Five Visits 15.97% Well-Child Visits in the First 15 Months of Life--Six or More Visits 55.32% Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life 67.59% Ambulatory Care Rates reported in Appendix F Board Certification Rates reported in Appendix F Enrollment by Product Line--Total Rates reported in Appendix F Enrollment by State Rates reported in Appendix F Frequency of Selected Procedures Rates reported in Appendix F Identification of Alcohol and Other Drug Services--Total Rates reported in Appendix F Language Diversity of Membership Rates reported in Appendix F Mental Health Utilization Rates reported in Appendix F Peach State Health Plan Validation of Performance Measures State of Georgia Page D-4 Peach State_GA2012-13_CMO_PMV_F1_0913 FINAL AUDITED HEDIS RATES Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for Peach State Health Plan Measure CMO Rate Race/Ethnicity Diversity of Membership Rates reported in Appendix F Total Membership Rates reported in Appendix F Weeks of Pregnancy at Time of Enrollment Rates reported in Appendix F * The measure is reported as an inverted rate. A higher rate indicates appropriate treatment of children with URI, for example (i.e., the proportion for whom antibiotics were not prescribed). The rate is calculated as 1 minus the numerator divided by the eligible population. ** Lower rate is better. Peach State Health Plan Validation of Performance Measures State of Georgia Page D-5 Peach State_GA2012-13_CMO_PMV_F1_0913 Appendix E. Performance Measure Validation Reporting Spreadsheet for Peach State Health Plan Appendix E contains Peach State Health Plan's performance measure validation reporting spreadsheet. Peach State Health Plan Validation of Performance Measures State of Georgia Page E-1 Peach State_GA2012-13_CMO_PMV_F1_0913 Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for Peach State 2013 Validation of Performance Measures Rate Reporting Template CMO Name: Peach State Health Plan CMO Contact Name and Title: Joyce McElwain, Senior Director of QI CMO Contact Email: Comments: jmcelwain@centene.com FINAL Rates for 5/24/2013 1 of 12 September 2013 Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for Peach State Cesarean Delivery Rate Data Element Reporting Year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate General Measure Data 2013 A 14830 4451 30.01 2 of 12 September 2013 Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for Peach State Percentage of Eligibles that Received Preventive Dental Services Data Element Reporting Year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate General Measure Data 2013 A 318356 153003 48.06% 3 of 12 September 2013 Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for Peach State Percentage of Eligibles that Received Dental Treatment Services Data Element Reporting Year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate General Measure Data 2013 A 318356 73680 23.14% 4 of 12 September 2013 Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for Peach State Cesarean Rate for Nulliparous Singleton Vertex Data Element Reporting Year General Measure Data 2013 Data collection methodology (administrative) A Eligible population 5410 Numerator events by administrative data 1062 Reported rate 19.63% 5 of 12 September 2013 Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for Peach State Percentage of Live Births Weighing Less Than 2,500 Grams Data Element Reporting Year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate General Measure Data 2013 A 16875 1440 8.53 6 of 12 September 2013 Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for Peach State Annual Percentage of Asthma Patients with One or More AsthmaRelated Emergency Room Visit (ages 2-20) Data Element Reporting Year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate General Measure Data 2013 A 34088 4309 12.64% 7 of 12 September 2013 Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for Peach State Annual Pediatric Hemoglobin (HbA1c) Testing (ages 5-17) Data Element Reporting Year Data collection methodology (hybrid) Eligible population Denominator Numerator events by administrative data Numerator events by medical records Numerator Total Reported rate General Measure Data 2013 H 368 361 295 6 301 83.38% 8 of 12 September 2013 Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for Peach State Diabetes, Short-Term Complications Admission Rate Data Element General Measure Data Reporting Year 2013 Data collection methodology (administrative) A Eligible population 199874 Numerator events by administrative data 51 Reported rate (Per 100,000 Members) 26 9 of 12 September 2013 Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for Peach State Chronic Obstructive Pulmonary Disease (COPD) Admission Rate Data Element General Measure Data Reporting Year 2013 Data collection methodology (administrative) A Eligible population 90097 Numerator events by administrative data 17 Reported rate (Per 100,000 Members) 19 10 of 12 September 2013 Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for Peach State Congestive Heart Failure (CHF) Admission Rate Data Element General Measure Data Reporting Year 2013 Data collection methodology (administrative) A Eligible population 90097 Numerator events by administrative data 23 Reported rate (Per 100,000 Members) 26 11 of 12 September 2013 Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for Peach State Adult Asthma Admission Rate Data Element Reporting Year General Measure Data 2013 Data collection methodology (administrative) A Eligible population 90097 Numerator events by administrative data 47 Reported rate (Per 100,000 Members) 52 12 of 12 September 2013 Appendix F. HEDIS Interactive Data Submission System Data for Peach State Health Plan Appendix F contains Peach State Health Plan's reported IDSS data. Peach State Health Plan Validation of Performance Measures State of Georgia Page F-1 Peach State_GA2012-13_CMO_PMV_F1_0913 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Audit Review Table Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None); Measurement Year - 2012 The Auditor lock has been applied to this submission. Pharmacy Reversal - Pharmacy Reversals NOT Included Measure/Data Element Report Measure Benefit Offered Rotated Measure Rate Reportable Effectiveness of Care: Prevention and Screening Adult BMI Assessment (aba) Y N 66.59% R Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Y N (wcc) BMI Percentile 47.69% R Counseling for Nutrition 56.02% R Counseling for Physical Activity 47.69% R Childhood Immunization Status (cis) Y DTaP N 81.86% R IPV 94.65% R MMR 95.12% R HiB 94.19% R Hepatitis B 96.05% R VZV 94.42% R Pneumococcal Conjugate 82.79% R Hepatitis A 90.23% R Rotavirus 70.23% R Influenza 38.14% R Combination #2 80.47% R Combination #3 76.74% R Combination #4 74.88% R Combination #5 60.00% R Combination #6 33.26% R Combination #7 58.60% R Combination #8 32.79% R Combination #9 28.37% R Combination #10 27.91% R Immunizations for Adolescents (ima) Y Meningococcal 72.92% R 1 of 143 Comment Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Tdap/Td 85.19% R Combination #1 71.30% R Human Papillomavirus Vaccine for Female Adolescents (hpv) Y 17.82% R Lead Screening in Children (lsc) Y N 74.19% R Breast Cancer Screening (bcs) Y 56.46% R Cervical Cancer Screening (ccs) Y 73.54% R Chlamydia Screening in Women (chl) Y 16-20 Years 54.68% R 21-24 Years 72.93% R Total 59.60% R Effectiveness of Care: Respiratory Conditions Appropriate Testing for Children with Pharyngitis (cwp) Y Y 73.80% R Appropriate Treatment for Children With URI (uri) Y Y 80.47% R Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (aab) Y Y Use of Spirometry Testing in the Assessment and Diagnosis of COPD (spr) Y Pharmacotherapy Management of COPD Exacerbation (pce) Y Y Systemic Corticosteroid Bronchodilator Use of Appropriate Medications for People With Asthma (asm) Y Y 5-11 Years 12-18 Years 19-50 Years 51-64 Years Total Medication Management for People With Asthma (mma) Y Y 5-11 Years - Medication Compliance 50% 5-11 Years - Medication Compliance 75% 12-18 Years - Medication Compliance 50% 17.31% R 40.82% R 63.64% R 78.18% R 90.58% R 88.40% R 72.39% R NA R 89.22% R 40.43% R 19.27% R 38.32% R 2 of 143 Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Denominator fewer than 30 Reportable Reportable Reportable Reportable September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 12-18 Years - Medication Compliance 75% 16.75% R 19-50 Years - Medication Compliance 50% 50.00% R 19-50 Years - Medication Compliance 75% 16.67% R 51-64 Years - Medication Compliance 50% NA R 51-64 Years - Medication Compliance 75% NA R Total - Medication Compliance 50% 40.08% R Total - Medication Compliance 75% 18.44% R Asthma Medication Ratio (amr) Y Y 5-11 Years 62.68% R 12-18 Years 58.92% R 19-50 Years 40.60% R 51-64 Years NA R Total 60.77% R Effectiveness of Care: Cardiovascular Cholesterol Management for Patients With Cardiovascular Conditions (cmc) Y N LDL-C Screening Performed 74.55% R LDL-C Control (<100 mg/dL) 23.64% R Controlling High Blood Pressure (cbp) Y 49.78% R Persistence of Beta-Blocker Treatment After a Y Y Heart Attack (pbh) NA R Effectiveness of Care: Diabetes Comprehensive Diabetes Care (cdc) Y N Hemoglobin A1c (HbA1c) Testing 79.83% R HbA1c Poor Control (>9.0%) 55.48% R HbA1c Control (<8.0%) 39.13% R HbA1c Control (<7.0%) 27.61% R Eye Exam (Retinal) Performed 57.22% R LDL-C Screening Performed 67.83% R LDL-C Control (<100 mg/dL) 20.35% R Medical Attention for Nephropathy 73.39% R Blood Pressure Control (<140/80 mm Hg) 27.30% R Blood Pressure Control (<140/90 mm Hg) 53.74% R Effectiveness of Care: Musculoskeletal Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis (art) Y Y 68.42% R 3 of 143 Reportable Reportable Reportable Denominator fewer than 30 Denominator fewer than 30 Reportable Reportable Reportable Reportable Reportable Denominator fewer than 30 Reportable Reportable Reportable Reportable Denominator fewer than 30 Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Use of Imaging Studies for Low Back Pain (lbp) Y Effectiveness of Care: Behavioral Health Antidepressant Medication Management (amm) Y Y Effective Acute Phase Treatment Effective Continuation Phase Treatment Follow-Up Care for Children Prescribed ADHD Medication (add) Y Y Initiation Phase Continuation and Maintenance (C&M) Phase Follow-Up After Hospitalization for Mental Illness (fuh) Y Y 30-Day Follow-Up 7-Day Follow-Up Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Y Y Medication (ssd) Diabetes Monitoring for People With Diabetes and Schizophrenia (smd) Y Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (smc) Y Adherence to Antipsychotic Medications for Individuals With Schizophrenia (saa) Y Y Effectiveness of Care: Medication Management Annual Monitoring for Patients on Persistent Medications (mpm) Y Y ACE Inhibitors or ARBs Digoxin Diuretics Anticonvulsants Total Access/Availability of Care Adults' Access to Preventive/Ambulatory Health Services (aap) Y 20-44 Years 45-64 Years 65+ Years 78.26% R 43.92% R 28.13% R 43.73% R 58.60% R 70.79% R 52.52% R 82.79% R NA R NA R 30.43% R 87.92% R NA R 87.90% R 63.41% R 86.87% R 84.94% R 89.36% R NA R 4 of 143 Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Denominator fewer than 30 Denominator fewer than 30 Reportable Reportable Denominator fewer than 30 Reportable Reportable Reportable Reportable Reportable Denominator fewer than 30 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Total 85.46% R Children and Adolescents' Access to Primary Care Practitioners (cap) Y 12-24 Months 96.98% R 25 Months - 6 Years 90.43% R 7-11 Years 90.81% R 12-19 Years 87.97% R Annual Dental Visit (adv) Y Y 2-3 Years 43.96% R 4-6 Years 76.01% R 7-10 Years 78.32% R 11-14 Years 70.02% R 15-18 Years 59.42% R 19-21 Years 38.85% R Total 67.92% R Initiation and Engagement of AOD Dependence Treatment (iet) Y Y Initiation of AOD Treatment: 13-17 Years 34.86% R Engagement of AOD Treatment: 13-17 Years 14.79% R Initiation of AOD Treatment: 18+ Years 41.00% R Engagement of AOD Treatment: 18+ Years 6.58% R Initiation of AOD Treatment: Total 39.74% R Engagement of AOD Treatment: Total 8.27% R Prenatal and Postpartum Care (ppc) Y Timeliness of Prenatal Care 86.71% R Postpartum Care 71.56% R Call Answer Timeliness (cat) Y 82.84% R Utilization Frequency of Ongoing Prenatal Care (fpc) Y <21 Percent 8.62% R 21-40 Percent 4.43% R 41-60 Percent 6.99% R 61-80 Percent 14.92% R 81+ Percent 65.03% R Well-Child Visits in the First 15 Months of Life (w15) Y N 5 of 143 Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 0 Visits 4.63% R 1 Visit 3.24% R 2 Visits 4.86% R 3 Visits 4.63% R 4 Visits 11.34% R 5 Visits 15.97% R 6+ Visits 55.32% R Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (w34) Y N 67.59% R Adolescent Well-Care Visits (awc) Y N 43.98% R Frequency of Selected Procedures (fsp) Y R Ambulatory Care: Total (amba) Y R Ambulatory Care: Dual Eligibles (ambb) N NR Ambulatory Care: Disabled (ambc) N NR Ambulatory Care: Other (ambd) N NR Inpatient Utilization--General Hospital/Acute Care: Total (ipua) Y R Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (ipub) N NR Inpatient Utilization--General Hospital/Acute Care: Disabled (ipuc) N NR Inpatient Utilization--General Hospital/Acute Care: Other (ipud) N NR Identification of Alcohol and Other Drug Services: Total (iada) Y Y R Identification of Alcohol and Other Drug Services: Dual Eligibles (iadb) N N NR Identification of Alcohol and Other Drug Services: Disabled (iadc) N N NR Identification of Alcohol and Other Drug Services: Other (iadd) N N NR Mental Health Utilization: Total (mpta) Y Y R Mental Health Utilization: Dual Eligibles (mptb) N N NR Mental Health Utilization: Disabled (mptc) N N NR Mental Health Utilization: Other (mptd) N N NR Antibiotic Utilization: Total (abxa) Y Y R Antibiotic Utilization: Dual Eligibles (abxb) N N NR 6 of 143 Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Measure Unselected Measure Unselected Measure Unselected Reportable Measure Unselected Measure Unselected Measure Unselected Reportable Measure Unselected Measure Unselected Measure Unselected Reportable Measure Unselected Measure Unselected Measure Unselected Reportable Measure Unselected September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Antibiotic Utilization: Disabled (abxc) N N NR Antibiotic Utilization: Other (abxd) N N NR Relative Resource Use Relative Resource Use for People With Diabetes (rdi) Y R Relative Resource Use for People With Asthma (ras) Y Y R Relative Resource Use for People With Cardiovascular Conditions (rca) Y R Relative Resource Use for People With Hypertension (rhy) Y R Relative Resource Use for People With COPD (rco) Y R Health Plan Descriptive Information Board Certification (bcr) N NR Total Membership (tlm) Y R Enrollment by Product Line: Total (enpa) Y R Enrollment by Product Line: Dual Eligibles (enpb) N NR Enrollment by Product Line: Disabled (enpc) N NR Enrollment by Product Line: Other (enpd) N NR Enrollment by State (ebs) Y R Race/Ethnicity Diversity of Membership (rdm) Y R Language Diversity of Membership (ldm) Y R Weeks of Pregnancy at Time of Enrollment in MCO (wop) Y R Measure Unselected Measure Unselected Reportable Reportable Reportable Reportable Reportable Measure Unselected Reportable Reportable Measure Unselected Measure Unselected Measure Unselected Reportable Reportable Reportable Reportable 7 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Adult BMI Assessment (ABA) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative or hybrid) Eligible population Number of numerator events by administrative data in eligible population (before exclusions) Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of administrative data records excluded Number of medical records excluded Number of employee/dependent medical records excluded Records added from the oversample list Denominator Numerator events by administrative data Numerator events by medical records Reported rate Lower 95% confidence interval Upper 95% confidence interval Measure Data 2012 H 7401 370 5.00% 411 0.05 432 29 6.71% 0 0 1 0 0 431 29 258 66.59% 62.02% 71.16% 8 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element BMI Percentile 3-11 years 12-17 years Total Counseling for Nutrition 3-11 years 12-17 years Total Measurement year 2012 2012 Data collection methodology (administrative or hybrid) H H Eligible population 77173 34466 111,639 77173 34466 111,639 Number of numerator events by administrative data in eligible population (before exclusions) 7682 3119 10,801 2587 1286 3,873 Current year's administrative rate (before exclusions) 9.95% 9.05% 9.67% 3.35% 3.73% 3.47% Minimum required sample size (MRSS) or other sample size 411 411 Oversampling rate 0.05 0.05 Final sample size 432 432 Number of numerator events by administrative data in FSS 43 28 71 9 10 19 Administrative rate on FSS 9.95% 6.48% 16.44% 2.08% 2.31% 4.40% Number of original sample records excluded because of valid 0 0 data errors Number of administrative data records excluded 0 0 Number of medical records excluded 0 0 Number of employee/dependent medical records excluded 0 0 Records added from the oversample list 0 0 Denominator 303 129 432 303 129 432 Numerator events by administrative data 43 28 71 9 10 19 Numerator events by medical records 101 34 135 165 58 223 Reported rate 47.52% 48.06% 47.69% 57.43% 52.71% 56.02% Lower 95% confidence interval 41.74% 39.05% 42.86% 51.69% 43.71% 51.22% Upper 95% confidence interval 53.31% 57.07% 52.51% 63.16% 61.72% 60.82% Counselin 3-11 years 77173 2114 2.74% 8 1.85% 303 8 129 45.21% 39.45% 50.98% 9 of 143 September 2013 ng for Physical Activity 12-17 years Total 2012 H 34466 111,639 1060 3,174 3.08% 411 0.05 432 7 1.62% 2.84% 15 3.47% 0 0 0 0 0 129 7 62 53.49% 44.49% 62.48% 432 15 191 47.69% 42.86% 52.51% Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 10 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Childhood Immunization Status (CIS) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element General Measure DTaP IPV Data Measurement year Data collection methodology (administrative or hybrid) Eligible population Number of numerator events by admin data in eligible population (before exclusions) Current year's administrative rate (before exclusions) 2012 H 7800 6290 80.64% 7189 92.17% Minimum required sample size (MRSS) or other sample Size 411 Oversampling rate Final sample size Number of numerator events by admin data in FSS Administrative rate on FSS 0.05 432 334 393 77.31% 90.97% Number of original records excluded because of valid data errors 1 Number of administrative data records excluded 0 Number of medical data records excluded 1 Number of employee/dependent medical records excluded 0 Records added from the oversample list 0 Denominator 430 Numerator events by administrative data 334 393 Number of numerator events by medical records 18 14 Reported rate 81.86% 94.65% Lower 95% confidence interval 78.10% 92.41% Upper 95% confidence interval 85.62% 96.89% MMR 7159 91.78% 406 93.98% 406 3 95.12% 92.96% 97.27% HiB Hepatitis B VZV 7237 92.78% 7081 90.78% 7213 92.47% 397 91.90% 385 89.12% 401 92.82% 397 8 94.19% 91.86% 96.51% 385 28 96.05% 94.09% 98.00% 401 5 94.42% 92.13% 96.70% 11 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Pneumococcal Conjugate Hepatitis A Rotavirus Influenza Combination Combination Combination Combination Combination Combination Combination Combination 2 3 4 5 6 7 8 9 6304 80.82% 7124 91.33% 5115 65.58% 2971 38.09% 5950 76.28% 5637 72.27% 5556 71.23% 4239 54.35% 2524 32.36% 4177 53.55% 2497 32.01% 2042 26.18% 338 78.24% 388 89.81% 268 62.04% 161 37.27% 325 75.23% 307 71.06% 301 69.68% 225 52.08% 132 30.56% 220 50.93% 130 30.09% 107 24.77% 338 18 82.79% 79.11% 86.47% 388 0 90.23% 87.31% 93.15% 268 34 70.23% 65.79% 74.67% 161 3 38.14% 33.43% 42.85% 325 21 80.47% 76.60% 84.33% 307 23 76.74% 72.63% 80.85% 301 21 74.88% 70.67% 79.10% 225 33 60.00% 55.25% 64.75% 132 11 33.26% 28.69% 37.83% 220 32 58.60% 53.83% 63.38% 130 11 32.79% 28.24% 37.34% 107 15 28.37% 23.99% 32.75% 12 of 143 September 2013 Combination 10 2018 25.87% 105 24.31% 105 15 27.91% 23.55% 32.26% 13 of 143 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Immunizations for Adolescents (IMA) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative or hybrid) Eligible population Number of numerator events by admin data in eligible population (before exclusions) Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample Size Oversampling rate Final sample size Number of numerator events by admin data in FSS Administrative rate on FSS Number of original records excluded because of valid data errors Number of administrative data records excluded Number of medical data records excluded Number of employee/dependent medical records excluded Records added from the oversample list Denominator Numerator events by administrative data Number of numerator events by medical records Reported rate Lower 95% confidence interval Upper 95% confidence interval General Measure Data 2012 H 8264 411 0.05 432 0 0 0 0 0 432 Meningococcal 6084 73.62% 310 71.76% 310 5 72.92% 68.61% 77.22% Tdap/Td 6894 83.42% 363 84.03% 363 5 85.19% 81.72% 88.65% Combination 1 5971 72.25% 303 70.14% 303 5 71.30% 66.91% 75.68% 14 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Human Papillomavirus Vaccine for Female Adolescents (HPV) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative or hybrid) Eligible population Measure Data 2012 H 4063 Number of numerator events by administrative data in eligible population (before exclusions) 755 Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of administrative data records excluded Number of medical data records excluded Number of employee/dependent medical records excluded Records added from the oversample list Denominator Numerator events by administrative data Numerator events by medical records Reported rate Lower 95% confidence interval Upper 95% confidence interval 18.58% 411 0.05 432 76 17.59% 0 0 0 0 0 432 76 1 17.82% 14.10% 21.55% 15 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Lead Screening in Children (LSC) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Lead Screening in Children Data Elements which do not apply to the selected data collection methodology will not appear Measurement year Data collection methodology (administrative or hybrid) Eligible population Number of numerator events by admin data in eligible population (before exclusions) Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of administrative data records excluded Number of medical data records excluded Number of employee/dependent medical records excluded Records added from the oversample list Denominator Numerator events by administrative data Numerator events by medical records Reported rate Lower 95% confidence interval Upper 95% confidence interval General Measure Data 2012 H 7800 5618 72.03% 411 0.05 432 310 71.76% 1 0 1 0 0 430 310 9 74.19% 69.93% 78.44% 16 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Breast Cancer Screening (BCS) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval General Measure Data 2012 A 1371 774 56.46% 53.79% 59.12% 17 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Cervical Cancer Screening (CCS) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative or hybrid) Eligible population Number of numerator events by administrative data in eligible population (before exclusions) Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of administrative data records excluded Number of medical data records excluded Number of employee/dependent medical records excluded Records added from the oversample list Denominator Numerator events by administrative data Numerator events by medical records Reported rate Lower 95% confidence interval Upper 95% confidence interval Measure Data 2012 H 12187 8091 66.39% 411 0.05 432 296 68.52% 0 1 4 0 0 427 296 18 73.54% 69.23% 77.84% 18 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Chlamydia Screening in Women (CHL) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval General Measure Data 2012 A 16-20 years 21-24 years 5139 2810 54.68% 53.31% 56.05% 1895 1382 72.93% 70.90% 74.96% Total 7,034 4,192 59.60% 58.44% 60.75% 19 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Appropriate Testing for Children with Pharyngitis (CWP) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval Measure Data 2012 A 11779 8693 73.80% 73.00% 74.60% 20 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Appropriate Treatment for Children With URI (URI) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval Measure Data 2012 A 19042 3719 80.47% 79.90% 81.04% 21 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Total numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval Measure Data 2012 A 595 492 17.31% 14.19% 20.44% 22 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval Measure Data 2012 A 49 20 40.82% 26.03% 55.60% 23 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Pharmacotherapy Management of COPD Exacerbation (PCE) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Pharmacotherapy Management of COPD Exacerbation Data Elements Measure Data Systemic corticosteroid Bronchodilator Measurement year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval 2012 A 55 35 63.64% 50.01% 77.26% 43 78.18% 66.36% 90.01% 24 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Use of Appropriate Medications for People With Asthma (ASM) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element General Measure Data 5-11 years 12-18 years 19-50 years 51-64 years Measurement year 2012 Data collection methodology (administrative) A Eligible population 2644 1319 134 12 Number of required exclusions 240 133 90 24 Numerator events by administrative data 2395 1166 97 8 Reported rate 90.58% 88.40% 72.39% NA Lower 95% confidence interval 89.45% 86.63% 64.45% NA Upper 95% confidence interval 91.71% 90.17% 80.33% NA Total 4,109 487 3,666 89.22% 88.26% 90.18% 25 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Medication Management for People With Asthma (MMA) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) 5-11 years 12-18 years 19-50 years 51-64 years Data Element General Medication Medication Medication Medication Medication Medication Medication Medication Measure Compliance Compliance Compliance Compliance Compliance Compliance Compliance Compliance Data 50% 75% 50% 75% 50% 75% 50% 75% Measurement year 2012 Data collection methodology (administrative) A Eligible population 2387 1164 96 8 Number of required exclusions 497 288 128 28 Numerator events by administrative data 965 460 446 195 48 16 6 3 Reported rate Lower 95% confidence interval Upper 95% confidence interval 40.43% 19.27% 38.32% 16.75% 50.00% 16.67% NA NA 38.44% 17.67% 35.48% 14.56% 39.48% 8.69% NA NA 42.42% 20.87% 41.15% 18.94% 60.52% 24.64% NA NA 26 of 143 September 2013 Total Medication Medication Compliance Compliance 50% 75% 3,655 941 1,465 674 40.08% 38.48% 41.68% 18.44% 17.17% 19.71% Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 27 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Asthma Medication Ratio (AMR) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measure Data 5-11 years 12-18 years 19-50 years Measurement year 2012 51-64 years Data collection methodology (administrative) A Eligible population Number of required exclusions Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval 2634 1312 133 12 250 140 91 24 1651 773 54 8 62.68% 58.92% 40.60% NA 60.81% 56.22% 31.88% NA 64.55% 61.62% 49.32% NA Total 4,091 505 2,486 60.77% 59.26% 62.28% 28 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Cholesterol Management for Patients With Cardiovascular Conditions (CMC) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative or hybrid) Eligible population Number of numerator events by administrative data in eligible population (before exclusions) Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of employee/dependent medical records excluded Records added from the oversample list Denominator Numerator events by administrative data Numerator events by medical records Reported rate Lower 95% confidence interval Upper 95% confidence interval General Measure Data 2012 H 55 55 0 55 0 0 0 55 LDL-C LDL-C level Screening <100 mg/dL 40 72.73% 3 5.45% 40 72.73% 3 5.45% 40 1 74.55% 62.12% 86.97% 3 10 23.64% 11.50% 35.77% 29 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Controlling High Blood Pressure (CBP) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (hybrid) Eligible population Number of numerator events by administrative data in eligible population (before exclusions) Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of records excluded because of false positive diagnoses Number of administrative data records excluded Number of medical data records excluded Number of employee/dependent medical records excluded Records added from the oversample list Denominator Numerator events by administrative data Numerator events by medical records Reported rate Lower 95% confidence interval Upper 95% confidence interval General Measure Data 2012 H 2288 0 0.00% 411 0.1 453 0 0.00% 0 0 0 1 0 0 452 0 225 49.78% 45.06% 54.50% 30 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Persistence of Beta-Blocker Treatment After a Heart Attack (PBH) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval Measure Data 2012 A 9 6 NA NA NA 31 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Comprehensive Diabetes Care (CDC) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element HbA1c Testing HbA1c Poor Control (>9.0%) HbA1c Control (<8.0%) HbA1c Control (<7.0%) for a Selected Population Measurement year Data collection methodology (administrative or hybrid) Eligible population Number of numerator events by administrative data in eligible population (before optional exclusions) Current year's administrative rate (before optional exclusions) Minimum required sample size (MRSS) or other sample size Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of optional administrative data records excluded Number of optional medical data records excluded Number of HbA1c <7 required medical records excluded Number of HbA1c <7 required administrative data records excluded Number of employee/dependent medical records excluded Records added from the oversample list Denominator 2012 H 1286 940 73.09% 548 0.05 576 448 77.78% 0 0 1 0 0 575 2012 H 1286 1055 82.04% 548 0.05 576 472 81.94% 0 0 1 0 0 575 2012 H 1286 199 15.47% 548 0.05 576 91 15.80% 0 0 1 0 0 575 2012 H 1106 126 11.39% 548 0.05 576 55 9.55% 0 0 1 4 82 0 0 489 Eye Exam 2012 H 1286 575 44.71% 548 0.05 576 258 44.79% 0 0 1 0 0 575 LDL-C Screening 2012 LDL-C Level <100 mg/dL Medical Attention for Nephropathy Blood Pressure Controlled <140/80 mm Hg 2012 2012 2012 H H H H 1286 1286 1286 1286 809 134 877 0 62.91% 548 0.05 576 382 66.32% 0 0 1 10.42% 548 0.05 576 58 10.07% 0 0 1 68.20% 548 0.05 576 402 69.79% 0 0 1 0.00% 548 0.05 576 0 0.00% 0 0 1 0 0 0 0 0 0 0 0 575 575 575 575 32 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Numerator events by administrative data Numerator events by medical records Reported rate Lower 95% confidence interval Upper 95% confidence interval 448 11 79.83% 76.46% 83.19% 256 63 55.48% 51.33% 59.63% 91 134 39.13% 35.05% 43.21% 55 80 27.61% 23.54% 31.67% 258 71 57.22% 53.09% 61.35% 382 8 67.83% 63.92% 71.73% 58 59 20.35% 16.97% 23.73% 402 20 73.39% 69.69% 77.09% 0 157 27.30% 23.58% 31.03% 33 of 143 September 2013 Blood Pressure Controlled <140/90 mm Hg 2012 H 1286 1 0.08% 548 0.05 576 0 0.00% 0 0 1 0 0 575 34 of 143 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State September 2013 0 309 53.74% 49.58% 57.90% Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 35 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Disease Modifying Anti-Rheumatic Drug therapy in Rheumatoid Arthritis (ART) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval Measure Data 2012 A 38 26 68.42% 52.33% 84.52% 36 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Use of Imaging Studies for Low Back Pain (LBP) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate Lower 95% confidence Interval Upper 95% confidence Interval Measure Data 2012 A 943 205 78.26% 75.58% 80.95% 37 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Antidepressant Medication Management (AMM) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval General Measure Data 2012 A 551 Effective Acute Phase Treatment Effective Continuation Phase Treatment 242 43.92% 39.69% 48.15% 155 28.13% 24.29% 31.98% 38 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Follow-Up Care for Children Prescribed ADHD Medication (ADD) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval General Measure Data 2012 A Initiation Phase Continuation and Maintenance Phase 3126 1367 43.73% 41.98% 45.48% 500 293 58.60% 54.18% 63.02% 39 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Follow-Up After Hospitalization for Mental Illness (FUH) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval General Measure Data 2012 A 1051 30-day 7-day follow- follow-up up 744 70.79% 67.99% 73.59% 552 52.52% 49.45% 55.59% 40 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication (SSD) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Number of required exclusions Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval Measure Data 2012 A 215 174 178 82.79% 77.51% 88.07% 41 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Number of optional exclusions Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval Measure Data 2012 A 14 0 12 NA NA NA 42 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval Measure Data 2012 A 0 0 NA NA NA 43 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Number of required exclusions Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval Measure Data 2012 A 46 27 14 30.43% 16.05% 44.82% 44 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Annual Monitoring for Patients on Persistent Medications (MPM) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element General Measure Data ACE Inhibitors or ARBs Digoxin Diuretics Measurement year 2012 Data collection methodology (administrative) A Eligible population 960 6 909 Numerator events by administrative data 844 5 799 Reported rate 87.92% NA 87.90% Lower 95% confidence interval 85.80% NA 85.72% Upper 95% confidence interval 90.03% NA 90.07% Anticonvulsants 82 52 63.41% 52.38% 74.45% Total 1,957 1,700 86.87% 85.35% 88.39% 45 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Adults' Access to Preventive/Ambulatory Health Services (AAP) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element General Measure Data 20-44 years 45-64 years 65+ years Measurement year 2012 Data collection methodology (administrative) A Eligible population 13623 1871 2 Numerator events by administrative data 11571 1672 0 Reported rate 84.94% 89.36% NA Lower 95% confidence interval 84.33% 87.94% NA Upper 95% confidence interval 85.54% 90.79% NA Total 15,496 13,243 85.46% 84.90% 86.02% 46 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Children and Adolescents' Access to Primary Care Practitioners (CAP) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element General Measure Data 12-24 months 25 months 6 years 7-11 years Measurement year 2012 Data collection methodology (administrative) A Eligible population 10453 53713 34089 Numerator events by administrative data 10137 48575 30956 Reported rate 96.98% 90.43% 90.81% Lower 95% confidence interval 96.64% 90.18% 90.50% Upper 95% confidence interval 97.31% 90.68% 91.12% 12-19 years 38693 34038 87.97% 87.64% 88.29% 47 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Annual Dental Visit (ADV) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measure Data 2-3 Years 4-6 Years 7-10 Years Measurement year 2012 Data collection methodology (administrative) A Eligible population 20313 34095 37981 Numerator events by administrative data 8929 25917 29748 Reported rate 43.96% 76.01% 78.32% Lower 95% confidence interval 43.27% 75.56% 77.91% Upper 95% confidence interval 44.64% 76.47% 78.74% 11-14 Years 15-18 Years 19-21 Years 34689 24288 70.02% 69.53% 70.50% 26133 15529 59.42% 58.83% 60.02% 1197 465 38.85% 36.04% 41.65% Total 154,408 104,876 67.92% 67.69% 68.15% 48 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Initiation and Engagement of AOD Dependence Treatment (IET) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Elements General Measure Data 13-17 years Initiation of Engagement AOD of AOD Treatment Treatment 18+ years Initiation of Engagement AOD of AOD Treatment Treatment Measurement year 2012 Data collection methodology (administrative) A Eligible population 284 1095 Numerator events by administrative data 99 42 449 72 Reported rate 34.86% 14.79% 41.00% 6.58% Lower 95% confidence interval 29.14% 10.48% 38.05% 5.06% Upper 95% confidence interval 40.58% 19.09% 43.96% 8.09% Total Initiation of Engagement AOD of AOD Treatment Treatment 1,379 548 114 39.74% 8.27% 37.12% 6.78% 42.36% 9.76% 49 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Prenatal and Postpartum Care (PPC) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative or hybrid) Eligible population Number of numerator events by administrative data in eligible population (before exclusions) Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of employee/dependent medical records excluded Records added from the oversample list Denominator Numerator events by administrative data Numerator events by medical records Reported rate Lower 95% confidence interval Upper 95% confidence interval Timeliness of Prenatal Care 2012 H 14968 5262 35.15% 411 0.05 432 147 34.03% 3 0 0 429 147 225 86.71% 83.38% 90.04% Postpartum Care 2012 H 14968 5919 39.54% 411 0.05 432 171 39.58% 3 0 0 429 171 136 71.56% 67.18% 75.95% 50 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Call Answer Timeliness (CAT) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate Lower 95% confidence interval Upper 95% confidence interval Measure Data 2012 A 258424 214083 82.84% 82.70% 82.99% 51 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Frequency of Ongoing Prenatal Care (FPC) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element General Measure Data <21 Percent Measurement year 2012 Data collection methodology (administrative or hybrid) H Eligible population 14968 Number of numerator events by administrative data in eligible population (before exclusions) 10631 Current year's administrative rate (before exclusions) 71.02% Minimum required sample size (MRSS) or other sample size 411 Oversampling rate 0.05 Final sample size (FSS) 432 Number of numerator events by administrative data in FSS 35 Administrative rate on FSS 8.10% Number of original sample records excluded because of valid data errors 3 Number of employee/dependent medical records excluded 0 Records added from the oversample list 0 Denominator 429 Numerator events by administrative data 35 Numerator events by medical records 2 Reported rate 8.62% Lower 95% confidence interval 5.85% Upper 95% confidence interval 11.40% 21-40 Percent 2354 15.73% 14 3.24% 14 5 4.43% 2.37% 6.49% 41-60 Percent 786 5.25% 10 2.31% 10 20 6.99% 4.46% 9.52% 61-80 Percent 81+ Percent 561 3.75% 636 4.25% 5 1.16% 18 4.17% 5 59 14.92% 11.43% 18.41% 18 261 65.03% 60.41% 69.66% 52 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Well-Child Visits in the First 15 Months of Life (W15) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measure Data 0 visits Measurement year 2012 Data collection methodology (administrative or hybrid) H Eligible population 8894 Number of numerator events by administrative data in eligible population (before exclusions) 530 Current year's administrative rate (before exclusions) 5.96% Minimum required sample size (MRSS) or other sample size 411 Oversampling rate 0.05 Final sample size (FSS) 432 Number of numerator events by administrative data in FSS 24 Administrative rate on FSS 5.56% Number of original sample records excluded because of valid data errors 0 Number of employee/dependent medical records excluded 0 Records added from the oversample list 0 Denominator 432 Numerator events by administrative data 20 Numerator events by medical records 0 Reported rate 4.63% Lower 95% confidence interval 2.53% Upper 95% confidence interval 6.73% 1 visit 548 6.16% 32 7.41% 14 0 3.24% 1.46% 5.03% 2 visits 3 visits 4 visits 5 visits 711 7.99% 833 9.37% 1173 13.19% 1658 18.64% 42 9.72% 39 9.03% 64 14.81% 68 15.74% 15 6 4.86% 2.72% 7.00% 13 7 4.63% 2.53% 6.73% 28 21 11.34% 8.24% 14.45% 31 38 15.97% 12.40% 19.54% 53 of 143 September 2013 6 or more visits 3441 38.69% 163 37.73% 166 73 55.32% 50.52% 60.13% Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 54 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Adolescent Well-Care Visits (AWC) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative or hybrid) Eligible population Number of numerator events by administrative data in eligible population (before exclusions) Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of employee/dependent medical records excluded Records added from the oversample list Denominator Numerator events by administrative data Numerator events by medical records Reported rate Lower 95% confidence interval Upper 95% confidence interval Measure Data 2012 H 53061 20725 39.06% 411 0.05 432 170 39.35% 0 0 0 432 170 20 43.98% 39.18% 48.78% 55 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Data Element Measurement year Data collection methodology (administrative or hybrid) Eligible population Number of numerator events by administrative data in eligible population (before exclusions) Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of employee/dependent medical records excluded Records added from the oversample list Denominator Numerator events by administrative data Numerator events by medical records Reported rate Lower 95% confidence interval Upper 95% confidence interval Measure Data 2012 H 45189 28394 62.83% 411 0.05 432 281 65.05% 0 0 0 432 281 11 67.59% 63.06% 72.12% 56 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Frequency of Selected Procedures (FSP) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age 0-9 10-19 15-44 20-44 30-64 45-64 Male 981,633 587,271 35,722 31,171 8,727 Female 959,960 615,903 631,816 386,763 29,486 Total 1,941,593 1,203,174 Procedure Age Sex Number of Procedures Procedures / 1,000 Member Years Bariatric weight loss surgery Tonsillectomy Hysterectomy, Abdominal Hysterectomy, Vaginal Cholecystectomy, Open Cholecystectomy (laparoscopic) Back Surgery 0-19 Male 0 0.00 Female 0 0.00 20-44 Male 0 0.00 Female 15 0.04 45-64 Male 0 0.00 Female 2 0.07 0-9 Male & 1413 0.73 10-19 Female 339 0.28 15-44 Female 124 0.20 45-64 30 1.02 15-44 Female 80 0.13 45-64 6 0.20 30-64 Male 0 0.00 15-44 Female 6 0.01 45-64 3 0.10 30-64 Male 12 0.38 15-44 397 0.63 Female 45-64 22 0.75 20-44 Male 9 0.25 Female 29 0.07 45-64 Male 3 0.34 57 of 143 September 2013 Mastectomy Lumpectomy Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 45-64 Female 11 0.37 15-44 Female 25 0.04 45-64 35 1.19 15-44 Female 130 0.21 45-64 35 1.19 58 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Ambulatory Care: Total (AMBA) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total Member Months 252,355 1,689,238 1,203,174 422,485 38,213 81 12 3 0 3,605,561 Outpatient Visits ED Visits Age Visits/ 1,000 Visits/ 1,000 Visits Member Visits Member Months Months <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total 194296 548448 272090 169557 25868 41 17 1 0 1,210,318 769.93 324.67 226.14 401.33 676.94 506.17 1,416.67 333.33 335.68 22354 84939 45547 49842 3226 2 1 0 0 205,911 88.58 50.28 37.86 117.97 84.42 24.69 83.33 0.00 57.11 59 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Ambulatory Care: Dual Eligibles (AMBB) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total Member Months NR NR NR NR NR NR NR NR NR NR Outpatient Visits ED Visits Age Visits/ 1,000 Visits/ 1,000 Visits Member Visits Member Months Months <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 60 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Ambulatory Care: Disabled (AMBC) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total Member Months NR NR NR NR NR NR NR NR NR NR Outpatient Visits ED Visits Age Visits/ 1,000 Visits/ 1,000 Visits Member Visits Member Months Months <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 61 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Ambulatory Care: Other (AMBD) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total Member Months NR NR NR NR NR NR NR NR NR NR Outpatient Visits ED Visits Age Visits/ 1,000 Visits/ 1,000 Visits Member Visits Member Months Months <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 62 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Inpatient Utilization--General Hospital/Acute Care: Total (IPUA) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total Member Months 252,355 1,689,238 1,203,174 422,485 38,213 81 12 3 0 3,605,561 Total Inpatient Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Discharges / Discharges 1,000 Member Months Days Days / 1,000 Members Months Average Length of Stay 1760 6.97 12680 50.25 7.20 1959 1.16 5721 3.39 2.92 3384 2.81 9793 8.14 2.89 15846 37.51 44671 105.73 2.82 479 12.54 2323 60.79 4.85 1 12.35 1 12.35 1.00 0 0.00 0 0.00 NA 0 0.00 0 0.00 NA 0 0 NA 63 of 143 September 2013 Total Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total 64 of 143 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 23,429 6.50 75,189 20.85 3.21 Medicine Discharges / Discharges 1,000 Member Months Days Days / 1,000 Members Months Average Length of Stay 1345 5.33 5634 22.33 4.19 1506 0.89 3892 2.30 2.58 623 0.52 1836 1.53 2.95 750 1.78 2666 6.31 3.55 242 6.33 942 24.65 3.89 1 12.35 1 12.35 1.00 0 0.00 0 0.00 NA 0 0.00 0 0.00 NA 0 0 NA 4,467 1.24 14,971 4.15 3.35 Surgery Discharges / Discharges 1,000 Member Months Days Days / 1,000 Members Months Average Length of Stay 415 453 399 563 215 0 0 0 0 2,045 1.64 7046 27.92 16.98 0.27 1829 1.08 4.04 0.33 1852 1.54 4.64 1.33 2735 6.47 4.86 5.63 1319 34.52 6.13 0.00 0 0.00 NA 0.00 0 0.00 NA 0.00 0 0.00 NA 0 NA 0.57 14,781 4.10 7.23 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Maternity* Discharges / Days / 1,000 Average Age Discharges 1,000 Member Days Members Length of Months Months Stay 10-19 2362 1.96 6105 5.07 2.58 20-44 14533 34.40 39270 92.95 2.70 45-64 22 0.58 62 1.62 2.82 Unknown 0 0 NA Total 16,917 10.17 45,437 27.31 2.69 *The maternity category is calculated using member months for members 10-64 years. 65 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (IPUB) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total Member Months NR NR NR NR NR NR NR NR NR NR Total Inpatient Discharges / Days / 1,000 Average Age Discharges 1,000 Member Days Members Length of Months Months Stay <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 66 of 143 September 2013 Total Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total 67 of 143 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State NR NR Medicine NR NR NR Discharges / Discharges 1,000 Member Months Days Days / 1,000 Members Months Average Length of Stay NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Surgery NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Discharges / Discharges 1,000 Member Months Days Days / 1,000 Members Months Average Length of Stay NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Maternity* NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Discharges / Days / 1,000 Average Age Discharges 1,000 Member Days Members Length of Months Months Stay 10-19 NR NR NR NR NR 20-44 NR NR NR NR NR 45-64 NR NR NR NR NR Unknown NR NR NR Total NR NR NR NR NR *The maternity category is calculated using member months for members 10-64 years. 68 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Inpatient Utilization--General Hospital/Acute Care: Disabled (IPUC) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total Member Months NR NR NR NR NR NR NR NR NR NR Total Inpatient Discharges / Days / 1,000 Average Age Discharges 1,000 Member Days Members Length of Months Months Stay <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 69 of 143 September 2013 Unknown Total Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total 70 of 143 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State NR NR NR Medicine NR NR NR NR NR Discharges / Discharges 1,000 Member Months Days Days / 1,000 Members Months Average Length of Stay NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Surgery NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Discharges / Discharges 1,000 Member Months Days Days / 1,000 Members Months Average Length of Stay NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Maternity* Discharges / Days / 1,000 Average Age Discharges 1,000 Member Days Members Length of Months Months Stay 10-19 NR NR NR NR NR 20-44 NR NR NR NR NR 45-64 NR NR NR NR NR Unknown NR NR NR Total NR NR NR NR NR *The maternity category is calculated using member months for members 10-64 years. 71 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Inpatient Utilization--General Hospital/Acute Care: Other (IPUD) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Member Months NR NR NR NR NR NR NR NR NR NR Total Inpatient Discharges / Discharges 1,000 Member Months Days Days / 1,000 Members Months Average Length of Stay NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 72 of 143 September 2013 Total Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total Age <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total 73 of 143 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State NR NR NR NR NR Medicine Discharges / Discharges 1,000 Member Months Days Days / 1,000 Members Months Average Length of Stay NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Surgery Discharges / Discharges 1,000 Member Months Days Days / 1,000 Members Months Average Length of Stay NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Maternity* September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Age Discharges / Discharges 1,000 Member Months Days Days / 1,000 Members Months 10-19 NR NR NR NR 20-44 NR NR NR NR 45-64 NR NR NR NR Unknown NR NR Total NR NR NR NR *The maternity category is calculated using member months for members 10-64 years. Average Length of Stay NR NR NR NR NR 74 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Identification of Alcohol and Other Drug Services: Total (IADA) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age 0-12 13-17 18-24 25-34 35-64 65+ Unknown Member Months (Any) Male 1214384 311821 47851 16997 22300 38 0 Female 1191808 322183 176261 191628 110232 58 0 Total 2,406,192 634,004 224,112 208,625 132,532 96 0 Member Months (Inpatient) Male 1214384 311821 47851 16997 22300 38 0 Female 1191808 322183 176261 191628 110232 58 0 Total 2,406,192 634,004 224,112 208,625 132,532 96 0 Member Months (Intensive Outpatient/Partial Hospitalization) Male Female Total 1214384 1191808 2,406,192 311821 322183 634,004 47851 176261 224,112 16997 191628 208,625 22300 110232 132,532 38 58 96 0 0 0 Member M Male 1214384 311821 47851 16997 22300 38 0 Total Age 0-12 13-17 18-24 25-34 35-64 65+ 1,613,391 Sex M F Total M F Total M F Total M F Total M F Total M F 1,992,170 3,605,561 Any Services Number 35 34 69 364 171 535 114 383 497 113 782 895 145 521 666 0 0 Percent 0.03% 0.03% 0.03% 1.40% 0.64% 1.01% 2.86% 2.61% 2.66% 7.98% 4.90% 5.15% 7.80% 5.67% 6.03% 0.00% 0.00% 1,613,391 1,992,170 Inpatient Number 6 3 9 42 34 76 13 139 152 22 221 243 34 117 151 0 0 Percent 0.01% 0.00% 0.00% 0.16% 0.13% 0.14% 0.33% 0.95% 0.81% 1.55% 1.38% 1.40% 1.83% 1.27% 1.37% 0.00% 0.00% 3,605,561 1,613,391 Intensive Outpatient/Partial Hospitalization Number Percent 0 0.00% 0 0.00% 0 0.00% 21 0.08% 5 0.02% 26 0.05% 3 0.08% 7 0.05% 10 0.05% 4 0.28% 29 0.18% 33 0.19% 4 0.22% 13 0.14% 17 0.15% 0 0.00% 0 0.00% 1,992,170 3,605,561 Outpatient/ED Number 30 31 61 336 154 490 110 283 393 106 655 761 131 471 602 0 0 Percent 0.03% 0.03% 0.03% 1.29% 0.57% 0.93% 2.76% 1.93% 2.10% 7.48% 4.10% 4.38% 7.05% 5.13% 5.45% 0.00% 0.00% 1,613,391 75 of 143 September 2013 Unknown Total Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Total 0 0.00% 0 0.00% 0 0.00% 0 0.00% M 0 NA 0 NA 0 NA 0 NA F 0 NA 0 NA 0 NA 0 NA Total 0 NA 0 NA 0 NA 0 NA M 771 0.57% 117 0.09% 32 0.02% 713 0.53% F 1,891 1.14% 514 0.31% 54 0.03% 1,594 0.96% Total 2,662 0.89% 631 0.21% 86 0.03% 2,307 0.77% 76 of 143 September 2013 Months (Outpatient/ED) Female 1191808 322183 176261 191628 110232 58 0 Total 2,406,192 634,004 224,112 208,625 132,532 96 0 1,992,170 3,605,561 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 77 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Identification of Alcohol and Other Drug Services: Dual Eligibles (IADB) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age Member Months (Any) Member Months (Inpatient) Member Months (Intensive Outpatient/Partial Hospitalization) Male Female Total Male Female Total Male Female Total 0-12 NR NR NR NR NR NR NR NR NR 13-17 NR NR NR NR NR NR NR NR NR 18-24 NR NR NR NR NR NR NR NR NR 25-34 NR NR NR NR NR NR NR NR NR 35-64 NR NR NR NR NR NR NR NR NR 65+ NR NR NR NR NR NR NR NR NR Unknown NR NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR NR Age Sex Any Services Inpatient Intensive Outpatient/Partial Hospitalization Outpatient/ED Number Percent Number Percent Number Percent Number Percent 0-12 M NR NR NR NR NR NR NR NR F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR 13-17 M NR NR NR NR NR NR NR NR F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR 18-24 M NR NR NR NR NR NR NR NR F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR 25-34 M NR NR NR NR NR NR NR NR F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR 35-64 F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR 65+ F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR Member Months (Outpatient/ED) Male NR NR NR NR NR NR NR NR Female NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR 78 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State M NR NR NR NR NR NR NR NR Unknown F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR Total F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR 79 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Identification of Alcohol and Other Drug Services: Disabled (IADC) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age Member Months (Any) Member Months (Inpatient) Member Months (Intensive Outpatient/Partial Hospitalization) Male Female Total Male Female Total Male Female Total 0-12 NR NR NR NR NR NR NR NR NR 13-17 NR NR NR NR NR NR NR NR NR 18-24 NR NR NR NR NR NR NR NR NR 25-34 NR NR NR NR NR NR NR NR NR 35-64 65+ NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Unknown NR NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR NR Any Services Age Sex Inpatient Intensive Outpatient/Partial Hospitalization Outpatient/ED Number Percent Number Percent Number Percent Number Percent 0-12 M NR NR NR NR NR NR NR NR F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR 13-17 M NR NR NR NR NR NR NR NR F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR 18-24 M NR NR NR NR NR NR NR NR F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR 25-34 M NR NR NR NR NR NR NR NR F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR 35-64 M NR NR NR NR NR NR NR NR F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR 65+ F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR Member Months (Outp Male NR NR NR NR NR NR NR NR Female NR NR NR NR NR NR NR NR 80 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Unknown Total M NR NR NR NR NR NR NR NR F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR 81 of 143 September 2013 patient/ED) Total NR NR NR NR NR NR NR NR Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 82 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 83 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Identification of Alcohol and Other Drug Services: Other (IADD) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age Member Months (Any) Member Months (Inpatient) Member Months (Intensive Outpatient/Partial Hospitalization) 0-12 13-17 18-24 25-34 35-64 65+ Unknown Total Male NR NR NR NR NR NR NR NR Female NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR Male NR NR NR NR NR NR NR NR Female NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR Male NR NR NR NR NR NR NR NR Female NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR Any Services Age Sex Inpatient Intensive Outpatient/Partial Hospitalization Outpatient/ED 0-12 13-17 18-24 25-34 35-64 65+ M F Total M F Total M F Total M F Total M F Total M F Total Number NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Percent NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Number NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Percent NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Number NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Percent NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Number NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Percent NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Member Months (Outpa Male NR NR NR NR NR NR NR NR Female NR NR NR NR NR NR NR NR 84 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State M NR NR NR NR NR NR NR NR Unknown F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR Total F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR 85 of 143 September 2013 atient/ED) Total NR NR NR NR NR NR NR NR Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 86 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 87 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Mental Health Utilization: Total (MPTA) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age Member Months (Any) Member Months (Inpatient) Member Months (Intensive Outpatient/Partial Hospitalization) Male Female Total Male Female Total Male Female Total 0-12 1214384 1191808 2,406,192 1214384 1191808 2,406,192 1214384 1191808 2,406,192 13-17 311821 322183 634,004 311821 322183 634,004 311821 322183 634,004 18-64 87148 478121 565,269 87148 478121 565,269 87148 478121 565,269 65+ 38 58 96 38 58 96 38 58 96 Unknown 0 0 0 0 0 0 0 0 0 Total 1,613,391 1,992,170 3,605,561 1,613,391 1,992,170 3,605,561 1,613,391 1,992,170 3,605,561 Any Services Age Sex Inpatient Intensive Outpatient/Partial Hospitalization Outpatient/ED Number Percent Number Percent Number Percent Number Percent M 8814 8.71% 127 0.13% 90 0.09% 8806 8.70% 0-12 F 5523 5.56% 86 0.09% 40 0.04% 5511 5.55% Total 14,337 7.15% 213 0.11% 130 0.06% 14,317 7.14% M 3407 13.11% 202 0.78% 85 0.33% 3380 13.01% 13-17 F 3224 12.01% 309 1.15% 98 0.37% 3188 11.87% Total 6,631 12.55% 511 0.97% 183 0.35% 6,568 12.43% M 633 8.72% 66 0.91% 16 0.22% 617 8.50% 18-64 F 4284 10.75% 323 0.81% 72 0.18% 4185 10.50% Total 4,917 10.44% 389 0.83% 88 0.19% 4,802 10.19% M 2 63.16% 0 0.00% 0 0.00% 2 63.16% 65+ F 0 0.00% 0 0.00% 0 0.00% 0 0.00% Total 2 25.00% 0 0.00% 0 0.00% 2 25.00% M 0 NA 0 NA 0 NA 0 NA Unknown F 0 NA 0 NA 0 NA 0 NA Total 0 NA 0 NA 0 NA 0 NA M 12,856 9.56% 395 0.29% 191 0.14% 12,805 9.52% Total F 13,031 7.85% 718 0.43% 210 0.13% 12,884 7.76% Total 25,887 8.62% 1,113 0.37% 401 0.13% 25,689 8.55% Member Months (Outpa Male 1214384 311821 87148 38 0 1,613,391 Female 1191808 322183 478121 58 0 1,992,170 88 of 143 September 2013 atient/ED) Total 2,406,192 634,004 565,269 96 0 3,605,561 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 89 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Mental Health Utilization: Dual Eligibles (MPTB) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Member Months (Any) Age Member Months (Inpatient) Member Months (Intensive Outpatient/Partial Hospitalization) Male Female Total Male Female Total Male Female Total 0-12 NR NR NR NR NR NR NR NR NR 13-17 NR NR NR NR NR NR NR NR NR 18-64 NR NR NR NR NR NR NR NR NR 65+ NR NR NR NR NR NR NR NR NR Unknown NR NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR NR Age Sex Any Services Inpatient Intensive Outpatient/Partial Hospitalization Outpatient/ED Number Percent Number Percent Number Percent Number Percent M NR NR NR NR NR NR NR NR 0-12 F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR 13-17 F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR 18-64 F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR 65+ F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR Unknown F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR Total F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR Member Months (Outpa Male NR NR NR NR NR NR Female NR NR NR NR NR NR 90 of 143 September 2013 atient/ED) Total NR NR NR NR NR NR Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 91 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Mental Health Utilization: Disabled (MPTC) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Member Months (Any) Age Member Months (Inpatient) Member Months (Intensive Outpatient/Partial Hospitalization) Male Female Total Male Female Total Male Female Total 0-12 NR NR NR NR NR NR NR NR NR 13-17 NR NR NR NR NR NR NR NR NR 18-64 NR NR NR NR NR NR NR NR NR 65+ NR NR NR NR NR NR NR NR NR Unknown NR NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR NR Age Sex Any Services Inpatient Intensive Outpatient/Partial Hospitalization Outpatient/ED Number Percent Number Percent Number Percent Number Percent M NR NR NR NR NR NR NR NR 0-12 F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR 13-17 F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR 18-64 F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR 65+ F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR Unknown F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR Total F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR Member Months (Outpa Male NR NR NR NR NR NR Female NR NR NR NR NR NR 92 of 143 September 2013 atient/ED) Total NR NR NR NR NR NR Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 93 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Mental Health Utilization: Other (MPTD) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Member Months (Any) Age Member Months (Inpatient) Member Months (Intensive Outpatient/Partial Hospitalization) Male Female Total Male Female Total Male Female Total 0-12 NR NR NR NR NR NR NR NR NR 13-17 NR NR NR NR NR NR NR NR NR 18-64 NR NR NR NR NR NR NR NR NR 65+ NR NR NR NR NR NR NR NR NR Unknown NR NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR NR Age Sex Any Services Inpatient Intensive Outpatient/Partial Hospitalization Outpatient/ED Number Percent Number Percent Number Percent Number Percent M NR NR NR NR NR NR NR NR 0-12 F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR 13-17 F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR 18-64 F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR 65+ F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR Unknown F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR M NR NR NR NR NR NR NR NR Total F NR NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR NR Member Months (Outpa Male NR NR NR NR NR NR Female NR NR NR NR NR NR 94 of 143 September 2013 atient/ED) Total NR NR NR NR NR NR Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 95 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Antibiotic Utilization: Total (ABXA) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Pharmacy Benefit Member Months Age Male Female Total 0-9 981633 959960 1,941,593 10-17 544572 554031 1,098,603 18-34 64848 367889 432,737 35-49 18172 96185 114,357 50-64 4128 14047 18,175 65-74 30 51 81 75-84 5 7 12 85+ 3 0 3 Unknown 0 0 0 Total 1,613,391 1,992,170 3,605,561 Antibiotic Utilization Age Sex Total Antibiotic Scrips Average Scrips PMPY for Antibiotics Total Days Supplied for All Antibiotic Scrips Average Days Supplied per Antibiotic Scrip Total Number of Scrips for Antibiotics of Concern Average Scrips PMPY for Anitbiotics of Concern Percentage of Antibiotics of Concern of all Antibiotic Scrips M 108170 1.32 993560 9.19 47696 0.58 44.09% 0-9 F 104930 1.31 979072 9.33 42998 0.54 40.98% Total 213,100 1.32 1,972,632 9.26 90,694 0.56 42.56% M 28550 0.63 288498 10.11 12923 0.28 45.26% 10-17 F 38727 0.84 371855 9.60 15983 0.35 41.27% Total 67,277 0.73 660,353 9.82 28,906 0.32 42.97% M 3998 0.74 39152 9.79 1601 0.30 40.05% 18-34 F 58649 1.91 454899 7.76 18641 0.61 31.78% Total 62,647 1.74 494,051 7.89 20,242 0.56 32.31% M 1691 1.12 15085 8.92 766 0.51 45.30% 35-49 F 15660 1.95 129488 8.27 6331 0.79 40.43% Total 17,351 1.82 144,573 8.33 7,097 0.74 40.90% M 349 1.01 3156 9.04 177 0.51 50.72% 50-64 F 2144 1.83 17906 8.35 1063 0.91 49.58% 96 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 65-74 75-84 85+ Unknown Total Age 0-9 10-17 18-34 35-49 Total M F Total M F Total M F Total M F Total M F Total Sex M F Total M F Total M F Total M F Total 2,493 3 1 4 0 3 3 0 0 0 0 0 0 142,761 220,114 362,875 Total Quinolone Scrips 42 73 115 259 669 928 257 4316 4,573 252 2034 2,286 1.65 21,062 8.45 1,240 0.82 49.74% 1.20 22 7.33 2 0.80 66.67% 0.24 10 10.00 0 0.00 0.00% 0.59 32 8.00 2 0.30 50.00% 0.00 0 NA 0 0.00 NA 5.14 20 6.67 2 3.43 66.67% 3.00 20 6.67 2 2.00 66.67% 0.00 0 NA 0 0.00 NA NA 0 NA 0 NA NA 0.00 0 NA 0 0.00 NA NA 0 NA 0 NA NA NA 0 NA 0 NA NA NA 0 NA 0 NA NA 1.06 1,339,473 9.38 63,165 0.47 44.25% 1.33 1,953,250 8.87 85,018 0.51 38.62% 1.21 3,292,723 9.07 148,183 0.49 40.84% Antibiotics of Concern Utilization Average Scrips PMPY for Quinolones Total Cephalosporin 2nd- 4th Generation Scrips Average Scrips PMPY for Cephalosporins 2nd- 4th Total Azithromycin and Clarithromycin Scrips Average Scrips PMPY for Azithromycins and Clarithro- mycins Generation Total Amoxicillin/ Clavulanate Scrips Average Scrips PMPY for Amoxicillin/ Clavulanates 0.00 8072 0.10 20350 0.25 17703 0.22 0.00 7549 0.09 18087 0.23 15900 0.20 0.00 15,621 0.10 38,437 0.24 33,603 0.21 0.01 1006 0.02 6933 0.15 3914 0.09 0.01 1269 0.03 8585 0.19 4440 0.10 0.01 2,275 0.02 15,518 0.17 8,354 0.09 0.05 50 0.01 815 0.15 303 0.06 0.14 620 0.02 9027 0.29 2642 0.09 0.13 670 0.02 9,842 0.27 2,945 0.08 0.17 20 0.01 292 0.19 135 0.09 0.25 168 0.02 2690 0.34 869 0.11 0.24 188 0.02 2,982 0.31 1,004 0.11 Total Ketolides Scrips 0 0 0 0 0 0 0 0 0 0 0 0 97 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 50-64 65-74 75-84 85+ Unknown Total Age 0-9 10-17 18-34 35-49 M F Total M F Total M F Total M F Total M F Total M F Total Sex M F Total M F Total M F Total M F 54 402 456 1 0 1 0 0 0 0 0 0 0 0 0 865 7,494 8,359 0.16 5 0.01 69 0.34 24 0.02 400 0.30 29 0.02 469 0.40 0 0.00 1 0.00 0 0.00 0 0.15 0 0.00 1 0.00 0 0.00 0 0.00 0 0.00 2 0.00 0 0.00 2 0.00 0 0.00 0 NA 0 NA 0 0.00 0 0.00 0 NA 0 NA 0 NA 0 NA 0 NA 0 NA 0 0.01 9,153 0.07 28,460 0.05 9,630 0.06 38,791 0.03 18,783 0.06 67,251 0.20 35 0.10 0 0.34 168 0.14 0 0.31 203 0.13 0 0.40 0 0.00 0 0.00 0 0.00 0 0.15 0 0.00 0 0.00 0 0.00 0 3.43 0 0.00 0 2.00 0 0.00 0 0.00 0 0.00 0 NA 0 NA 0 0.00 0 0.00 0 NA 0 NA 0 NA 0 NA 0 NA 0 NA 0 0.21 22,090 0.16 0 0.23 24,019 0.14 0 0.22 46,109 0.15 0 All Other Antibiotics Utilization Total Absorbable Sulfonamide Scrips Average Scrips PMPY for Absorbable Sulfonamides Total Aminoglycoside Scrips Average Scrips PMPY for Aminoglycosides Total 1st Generation Cephalosporin Scrips Average Scrips PMPY for 1st Generation Cephalosporins Total Lincosamide Scrips Total Average Scrips Macrolides PMPY for (not azith. or Lincosamides clarith.) Scrips 5181 0.06 5 0.00 5853 0.07 0 0.00 120 7945 0.10 6 0.00 6331 0.08 0 0.00 95 13,126 0.08 11 0.00 12,184 0.08 0 0.00 215 2104 0.05 8 0.00 2461 0.05 0 0.00 85 4071 0.09 2 0.00 2996 0.06 0 0.00 113 6,175 0.07 10 0.00 5,457 0.06 0 0.00 198 385 0.07 0 0.00 317 0.06 0 0.00 25 5185 0.17 0 0.00 3867 0.13 0 0.00 216 5,570 0.15 0 0.00 4,184 0.12 0 0.00 241 176 0.12 0 0.00 124 0.08 0 0.00 4 1620 0.20 0 0.00 1008 0.13 0 0.00 71 98 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Total 1,796 0.19 0 0.00 1,132 0.12 0 M 32 0.09 0 0.00 21 0.06 0 50-64 F 211 0.18 0 0.00 170 0.15 0 Total 243 0.16 0 0.00 191 0.13 0 M 0 0.00 0 0.00 0 0.00 0 65-74 F 0 0.00 0 0.00 1 0.24 0 Total 0 0.00 0 0.00 1 0.15 0 M 0 0.00 0 0.00 0 0.00 0 75-84 F 0 0.00 0 0.00 0 0.00 0 Total 0 0.00 0 0.00 0 0.00 0 M 0 0.00 0 0.00 0 0.00 0 85+ F 0 NA 0 NA 0 NA 0 Total 0 0.00 0 0.00 0 0.00 0 M 0 NA 0 NA 0 NA 0 Unknown F 0 NA 0 NA 0 NA 0 Total 0 NA 0 NA 0 NA 0 M 7,878 0.06 13 0.00 8,776 0.07 0 Total F 19,032 0.11 8 0.00 14,373 0.09 0 Total 26,910 0.09 21 0.00 23,149 0.08 0 0.00 75 0.00 3 0.00 9 0.00 12 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 NA 0 0.00 0 NA 0 NA 0 NA 0 0.00 237 0.00 504 0.00 741 99 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 100 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Average Scrips PMPY for Ketolides Total Clindamycin Scrips Average Scrips PMPY for Clindamycins Total Misc. Antibiotics of Concern Scrips Average Scrips PMPY for Misc. Antibiotics of Concern 0.00 1527 0.02 2 0.00 0.00 1385 0.02 4 0.00 0.00 2,912 0.02 6 0.00 0.00 809 0.02 2 0.00 0.00 1017 0.02 3 0.00 0.00 1,826 0.02 5 0.00 0.00 175 0.03 1 0.00 0.00 2032 0.07 4 0.00 0.00 2,207 0.06 5 0.00 0.00 67 0.04 0 0.00 0.00 569 0.07 1 0.00 0.00 636 0.07 1 0.00 101 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 0.00 14 0.04 0 0.00 0.00 66 0.06 3 0.00 0.00 80 0.05 3 0.00 0.00 0 0.00 0 0.00 0.00 0 0.00 0 0.00 0.00 0 0.00 0 0.00 0.00 0 0.00 0 0.00 0.00 0 0.00 0 0.00 0.00 0 0.00 0 0.00 0.00 0 0.00 0 0.00 NA 0 NA 0 NA 0.00 0 0.00 0 0.00 NA 0 NA 0 NA NA 0 NA 0 NA NA 0 NA 0 NA 0.00 2,592 0.02 5 0.00 0.00 5,069 0.03 15 0.00 0.00 7,661 0.03 20 0.00 Average Scrips PMPY for Macrolides (not azith. or clarith.) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.01 0.00 0.01 Total Penicillin Scrips 49151 47134 96,285 8513 10707 19,220 1045 10663 11,708 398 2825 Average Scrips PMPY for Penicillins Total Tetracycline Scrips Average Scrips PMPY for Tetracyclines Total Misc. Antibiotic Scrips Average Scrips PMPY for Misc. Antibiotics 0.60 23 0.00 141 0.00 0.59 10 0.00 411 0.01 0.60 33 0.00 552 0.00 0.19 2243 0.05 213 0.00 0.23 2559 0.06 2296 0.05 0.21 4,802 0.05 2,509 0.03 0.19 506 0.09 119 0.02 0.35 3926 0.13 16151 0.53 0.32 4,432 0.12 16,270 0.45 0.26 139 0.09 84 0.06 0.35 1081 0.13 2724 0.34 102 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 0.01 3,223 0.34 0.01 73 0.21 0.01 394 0.34 0.01 467 0.31 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 NA 0 NA 0.00 0 0.00 NA 0 NA NA 0 NA NA 0 NA 0.00 59,180 0.44 0.00 71,723 0.43 0.00 130,903 0.44 1,220 32 128 160 1 0 1 0 1 1 0 0 0 0 0 0 2,944 7,705 10,649 0.13 2,808 0.29 0.09 11 0.03 0.11 169 0.14 0.11 180 0.12 0.40 0 0.00 0.00 0 0.00 0.15 0 0.00 0.00 0 0.00 1.71 0 0.00 1.00 0 0.00 0.00 0 0.00 NA 0 NA 0.00 0 0.00 NA 0 NA NA 0 NA NA 0 NA 0.02 568 0.00 0.05 21,751 0.13 0.04 22,319 0.07 103 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Antibiotic Utilization: Dual Eligibles (ABXB) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Member Months Member Months Age Male Female Total 0-9 NR NR NR 10-17 NR NR NR 18-34 NR NR NR 35-49 NR NR NR 50-64 NR NR NR 65-74 NR NR NR 75-84 NR NR NR 85+ NR NR NR Unknown NR NR NR Total NR NR NR Antibiotic Utilization Percentage of Age Sex Total Antibiotic Scrips Average Scrips Total Days PMPY for Supplied for All Antibiotics Antibiotic Scrips Average Days Supplied per Antibiotic Scrip Total Number of Scrips for Antibiotics of Concern Average Scrips PMPY for Anitbiotics of Concern Antibiotics of Concern of all Antibiotic Scrips M NR NR NR 0-9 F NR NR NR Total NR NR NR M NR NR NR 10-17 F NR NR NR Total NR NR NR M NR NR NR 18-34 F NR NR NR Total NR NR NR M NR NR NR 35-49 F NR NR NR Total NR NR NR M NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 104 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 50-64 65-74 75-84 85+ Unknown Total Age 0-9 10-17 18-34 35-49 F Total M F Total M F Total M F Total M F Total M F Total Sex M F Total M F Total M F Total M F NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Antibiotics of Concern Utilization Total Quinolone Scrips Average Scrips PMPY for Quinolones Total Cephalosporin 2nd-4th Generation Scrips Average Scrips PMPY for Cephalosporins 2nd-4th Generation Total Azithromycin and Clarithromycin Scrips Average Scrips PMPY for Azithromycins and Clarithromycins Total Amoxicillin/ Clavulanate Scrips Average Scrips PMPY for Amoxicillin/ Clavulanates NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 105 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 50-64 65-74 75-84 85+ Unknown Total Age 0-9 10-17 18-34 Total M F Total M F Total M F Total M F Total M F Total M F Total Sex M F Total M F Total M F Total M NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR All Other Antibiotics Utilization Total Absorbable Sulfonamide Scrips Average Scrips PMPY for Absorbable Sulfonamides Total Aminoglycoside Scrips Average Scrips PMPY for Aminoglycosides Total 1st Generation Cephalosporin Scrips Average Scrips PMPY for 1st Generation Cephalosporins Total Average Scrips Lincosamide PMPY for Scrips Lincosamides NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 106 of 143 September 2013 35-49 F NR Total NR M NR 50-64 F NR Total NR M NR 65-74 F NR Total NR M NR 75-84 F NR Total NR M NR 85+ F NR Total NR M NR Unknown F NR Total NR M NR Total F NR Total NR Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 107 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 108 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Total Ketolides Scrips Average Scrips PMPY for Ketolides Total Clindamycin Scrips Average Scrips PMPY for Clindamycins Total Misc. Antibiotics of Concern Scrips Average Scrips PMPY for Misc. Antibiotics of Concern NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 109 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Total Macrolides (not azith. or clarith.) Scrips Average Scrips PMPY for Macrolides (not azith. or clarith.) Total Penicillin Scrips Average Scrips PMPY for Penicillins Total Tetracycline Scrips Average Scrips Total Misc. PMPY for Antibiotic Tetracyclines Scrips NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Average Scrips PMPY for Misc. Antibiotics NR NR NR NR NR NR NR NR NR NR 110 of 143 September 2013 NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 111 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Antibiotic Utilization: Disabled (ABXC) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Member Months Member Months Age Male Female Total 0-9 NR NR NR 10-17 NR NR NR 18-34 NR NR NR 35-49 NR NR NR 50-64 NR NR NR 65-74 NR NR NR 75-84 NR NR NR 85+ NR NR NR Unknown NR NR NR Total NR NR NR Antibiotic Utilization Age Sex Total Antibiotic Scrips Average Scrips Total Days PMPY for Supplied for All Antibiotics Antibiotic Scrips Average Days Supplied per Antibiotic Scrip Total Number of Scrips for Antibiotics of Concern Average Scrips PMPY for Anitbiotics of Concern Percentage of Antibiotics of Concern of all Antibiotic Scrips M NR NR NR 0-9 F NR NR NR Total NR NR NR M NR NR NR 10-17 F NR NR NR Total NR NR NR M NR NR NR 18-34 F NR NR NR Total NR NR NR M NR NR NR 35-49 F NR NR NR Total NR NR NR M NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 112 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 50-64 65-74 75-84 85+ Unknown Total Age 0-9 10-17 18-34 35-49 F Total M F Total M F Total M F Total M F Total M F Total Sex M F Total M F Total M F Total M F NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Antibiotics of Concern Utilization Total Quinolone Scrips Average Scrips PMPY for Quinolones Total Cephalosporin 2nd-4th Generation Scrips Average Scrips PMPY for Cephalosporins 2nd-4th Generation Total Azithromycin and Clarithromycin Scrips Average Scrips PMPY for Azithromycins and Clarithromycins Total Amoxicillin/ Clavulanate Scrips NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 113 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 50-64 65-74 75-84 85+ Unknown Total Age 0-9 10-17 18-34 Total M F Total M F Total M F Total M F Total M F Total M F Total Sex M F Total M F Total M F Total M NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR All Other Antibiotics Utiliz Total Absorbable Sulfonamide Scrips Average Scrips PMPY for Absorbable Sulfonamides Total Aminoglycoside Scrips Average Scrips PMPY for Aminoglycosides Total 1st Generation Cephalosporin Scrips Average Scrips PMPY for 1st Generation Cephalosporins Total Lincosamide Scrips NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 114 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 35-49 F NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR M NR NR NR NR NR NR NR 50-64 F NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR M NR NR NR NR NR NR NR 65-74 F NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR M NR NR NR NR NR NR NR 75-84 F NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR M NR NR NR NR NR NR NR 85+ F NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR M NR NR NR NR NR NR NR Unknown F NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR M NR NR NR NR NR NR NR Total F NR NR NR NR NR NR NR Total NR NR NR NR NR NR NR 115 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 116 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Average Scrips PMPY for Amoxicillin/ Clavulanates Total Ketolides Scrips Average Scrips PMPY for Ketolides Total Clindamycin Scrips Average Scrips PMPY for Clindamycins Total Misc. Average Scrips Antibiotics of PMPY for Misc. Concern Antibiotics of Scrips Concern NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 117 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR zation NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Average Scrips PMPY for Lincosamides Total Macrolides (not azith. or clarith.) Scrips Average Scrips PMPY for Macrolides (not azith. or clarith.) NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Total Penicillin Scrips NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Average Scrips Total Average Scrips Total Misc. PMPY for Tetracycline PMPY for Antibiotic Penicillins Scrips Tetracyclines Scrips Average Scrips PMPY for Misc. Antibiotics NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 118 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 119 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Antibiotic Utilization: Other (ABXD) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Member Months Member Months Age Male Female Total 0-9 NR NR NR 10-17 NR NR NR 18-34 NR NR NR 35-49 NR NR NR 50-64 NR NR NR 65-74 NR NR NR 75-84 NR NR NR 85+ NR NR NR Unknown NR NR NR Total NR NR NR Antibiotic Utilization Age Sex Total Antibiotic Scrips Average Scrips Total Days Average Days PMPY for Supplied for All Supplied per Antibiotics Antibiotic Scrips Antibiotic Scrip Total Number of Scrips for Antibiotics of Concern Average Scrips PMPY for Anitbiotics of Concern Percentage of Antibiotics of Concern of all Antibiotic Scrips M NR NR NR 0-9 F NR NR NR Total NR NR NR M NR NR NR 10-17 F NR NR NR Total NR NR NR M NR NR NR 18-34 F NR NR NR Total NR NR NR M NR NR NR 35-49 F NR NR NR Total NR NR NR M NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 120 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 50-64 65-74 75-84 85+ Unknown Total Age 0-9 10-17 18-34 35-49 F Total M F Total M F Total M F Total M F Total M F Total Sex M F Total M F Total M F Total M F NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Antibiotics of Concern Utilization Total Quinolone Scrips Average Scrips PMPY for Quinolones Total Cephalosporin 2nd-4th Generation Scrips Average Scrips PMPY for Cephalosporins 2nd-4th Generation Total Azithromycin and Clarithromycin Scrips Average Scrips PMPY for Azithromycins and Clarithromycins Total Amoxicillin/ Clavulanate Scrips Average Scrips PMPY for Amoxicillin/ Clavulanates NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 121 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 50-64 65-74 75-84 85+ Unknown Total Age 0-9 10-17 18-34 Total M F Total M F Total M F Total M F Total M F Total M F Total Sex M F Total M F Total M F Total M NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR All Other Antibiotics Utilization Total Absorbable Sulfonamide Scrips Average Scrips PMPY for Absorbable Sulfonamides Total Aminoglycoside Scrips Average Scrips PMPY for Aminoglycosides Total 1st Generation Cephalosporin Scrips Average Scrips PMPY for 1st Generation Cephalosporins Total Lincosamide Scrips Average Scrips PMPY for Lincosamides NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 122 of 143 September 2013 35-49 F NR Total NR M NR 50-64 F NR Total NR M NR 65-74 F NR Total NR M NR 75-84 F NR Total NR M NR 85+ F NR Total NR M NR Unknown F NR Total NR M NR Total F NR Total NR Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 123 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 124 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Total Ketolides Scrips Average Scrips PMPY for Ketolides Total Clindamycin Scrips Average Scrips PMPY for Clindamycins Total Misc. Average Scrips Antibiotics of PMPY for Misc. Concern Antibiotics of Scrips Concern NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 125 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Total Macrolides (not azith. or clarith.) Scrips Average Scrips PMPY for Macrolides (not azith. or clarith.) NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Total Penicillin Scrips NR NR NR NR NR NR NR NR NR NR Average Scrips PMPY for Penicillins Total Average Scrips Total Misc. Tetracycline PMPY for Antibiotic Scrips Tetracyclines Scrips Average Scrips PMPY for Misc. Antibiotics NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 126 of 143 September 2013 NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 127 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Board Certification (BCR) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Type of Physician Number of Physicians in Each Practice Area Board Certification Number Percent Family Medicine Internal Medicine OB/GYN physicians Pediatricians Geriatricians Other physician specialists NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 128 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Total Membership (TLM) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Product/Product Line HMO (Total) Medicaid Commercial Medicare (cost or risk) Other PPO (Total) Medicaid Commercial Medicare (cost or risk) Other POS (Total) Medicaid Commercial Medicare (cost or risk) Other FFS (Total) Medicaid Commercial Medicare (cost or risk) Other Total * Total number of members in each category as of December 31 of the measurement year. Total Number of Members* 313,692 313647 0 45 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 313,692 129 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Enrollment by Product Line: Total (ENPA) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age <1 1-4 5-9 10-14 15-17 18-19 0-19 Subtotal 0-19 Subtotal: % 20-24 25-29 30-34 35-39 40-44 20-44 Subtotal 20-44 Subtotal: % 45-49 50-54 55-59 60-64 45-64 Subtotal 45-64 Subtotal: % 65-69 70-74 75-79 80-84 85-89 >=90 >=65 Subtotal >=65 Subtotal: % Age Unknown Male Member Months 127864 404326 449443 370160 174412 42699 1,568,904 97.24% 5152 8126 8871 7442 6131 35,722 2.21% 4599 2601 1151 376 8,727 0.54% 12 18 3 2 1 2 38 0.00% 0 Female Member Months 124491 391071 444398 370850 183181 61872 1,575,863 79.10% 114389 108026 83602 51597 29149 386,763 19.41% 15439 8146 3914 1987 29,486 1.48% 46 5 7 0 0 0 58 0.00% 0 Total Member Months 252,355 795,397 893,841 741,010 357,593 104,571 3,144,767 87.22% 119,541 116,152 92,473 59,039 35,280 422,485 11.72% 20,038 10,747 5,065 2,363 38,213 1.06% 58 23 10 2 1 2 96 0.00% 0 130 of 143 September 2013 Total Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State 1,613,391 1,992,170 3,605,561 131 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Enrollment by Product Line: Dual Eligibles (ENPB) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age <1 1-4 5-9 10-14 15-17 18-19 0-19 Subtotal 0-19 Subtotal: % 20-24 25-29 30-34 35-39 40-44 20-44 Subtotal 20-44 Subtotal: % 45-49 50-54 55-59 60-64 45-64 Subtotal 45-64 Subtotal: % 65-69 70-74 75-79 80-84 85-89 >=90 >=65 Subtotal >=65 Subtotal: % Age Unknown Male Member Months NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Female Member Months NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Total Member Months NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 132 of 143 September 2013 Total Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State NR NR NR 133 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Enrollment by Product Line: Disabled (ENPC) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age <1 1-4 5-9 10-14 15-17 18-19 0-19 Subtotal 0-19 Subtotal: % 20-24 25-29 30-34 35-39 40-44 20-44 Subtotal 20-44 Subtotal: % 45-49 50-54 55-59 60-64 45-64 Subtotal 45-64 Subtotal: % 65-69 70-74 75-79 80-84 85-89 >=90 >=65 Subtotal >=65 Subtotal: % Age Unknown Male Member Months NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Female Member Months NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Total Member Months NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 134 of 143 September 2013 Total Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State NR NR NR 135 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Enrollment by Product Line: Other (ENPD) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Age <1 1-4 5-9 10-14 15-17 18-19 0-19 Subtotal 0-19 Subtotal: % 20-24 25-29 30-34 35-39 40-44 20-44 Subtotal 20-44 Subtotal: % 45-49 50-54 55-59 60-64 45-64 Subtotal 45-64 Subtotal: % 65-69 70-74 75-79 80-84 85-89 >=90 >=65 Subtotal >=65 Subtotal: % Age Unknown Male Member Months NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Female Member Months NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Total Member Months NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 136 of 143 September 2013 Total Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State NR NR NR 137 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Enrollment by State (EBS) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico Number 16 0 0 0 2 1 0 0 0 22 306046 0 0 3 1 1 0 1 3 0 0 0 0 4 4 1 0 0 1 0 2 0 138 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Commonwealth of Northern Marianas Puerto Rico Virgin Islands Other TOTAL 2 6 1 3 0 0 2 0 11 0 5 7 0 0 7 2 0 0 0 0 0 0 0 0 0 8 306,162 139 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Race/Ethnicity Diversity of Membership (RDM) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Race/Ethnicity Diversity of Membership Total Unduplicated Membership During the Measurement Year 433574 Percentage of Members for Whom the Organization has Race/Ethnicity Information by Data Collection Direct Data Collection Method Indirect Data Collection Method Direct Total 0.00% Race Health Plan Direct* CMS/State Database* 0.0000 0.0000 Indirect Total* 0.0000 Other* 0.0000 Direct Total 0.00% Ethnicity Health Plan Direct* CMS/State Database* 0.0000 0.0000 Indirect Total* 0.0000 Other* 0.0000 *Enter percentage as a value between 0 and 1. Race Hispanic or Latino Not Hispanic or Latino Number Percentage Number Percentage White 27198 79.34% 74257 30.71% Black or African American 766 2.23% 158422 65.52% American-Indian and Alaska Native 52 0.15% 130 0.05% Asian 168 0.49% 7375 3.05% Unknown Total* 1.0000 Total* 1.0000 Unknown Ethnicity Number Percentage 66 0.04% 81 0.05% 0 0.00% 5 0.00% Native Hawaiian and Other Pacific Islanders 94 0.27% 69 0.03% 0 0.00% Some Other Race Two or More Races Unknown Declined Total 6002 0 0 0 34,280 17.51% 0.00% 0.00% 0.00% 100.00% 1528 0 0 0 241,781 0.63% 0.00% 0.00% 0.00% 100.00% 3 0 157358 0 157,513 0.00% 0.00% 99.90% 0.00% 100.00% Declined Ethnicity Number Percentage 0 NR 0 NR 0 NR 0 NR 0 NR 0 NR 0 NR 0 NR 0 NR 0 NR Tot Number 101,521 159,269 182 7,548 163 7,533 0 157,358 0 433,574 140 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State tal Percentage 23.41% 36.73% 0.04% 1.74% 0.04% 1.74% 0.00% 36.29% 0.00% 100.00% 141 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Language Diversity of Membership (LDM) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Percentage of Members With Known Language Value from Each Data Source Category Health Plan Direct CMS/State Databases Other ThirdParty Source Spoken Language Preferred for Health Care* 0.0000 0.0000 1.0000 Preferred Language for Written Materials* 0.0000 0.0000 1.0000 Other Language Needs* 0.0000 0.0000 1.0000 *Enter percentage as a value between 0 and 1. Spoken Language Preferred for Health Care Number Percentage English 253553 58.48% Non-English 19108 4.41% Unknown 160913 37.11% Declined 0 0.00% Total* 433,574 100.00% Language Preferred for Written Materials Number Percentage English 0 0.00% Non-English 0 0.00% Unknown 433574 100.00% Declined 0 0.00% Total* 433,574 100.00% Other Language Needs Number Percentage English 0 0.00% Non-English 0 0.00% Unknown 433574 100.00% Declined 0 0.00% Total* *Should sum to 100% 433,574 100.00% 142 of 143 September 2013 Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State Weeks of Pregnancy at Time of Enrollment in MCO (WOP) Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None) Measurement Year Measurement Year Weeks of Pregnancy < 0 weeks 1-12 weeks 13-27 weeks 28 or more weeks Unknown Total 2012 Number 46 54 252 73 5 430 Percentage 10.70% 12.56% 58.60% 16.98% 1.16% 100.00% 143 of 143 September 2013